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Zhu J, Chen H, Wu J, Li S, Lin W, Wang N, Bai L. Ferroptosis in Glaucoma: A Promising Avenue for Therapy. Adv Biol (Weinh) 2024; 8:e2300530. [PMID: 38411382 DOI: 10.1002/adbi.202300530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 01/08/2024] [Indexed: 02/28/2024]
Abstract
Glaucoma, a blind-leading disease largely since chronic pathological intraocular high pressure (ph-IOP). Hitherto, it is reckoned incurable for irreversible neural damage and challenges in managing IOP. Thus, it is significant to develop neuroprotective strategies. Ferroptosis, initially identified as an iron-dependent regulated death that triggers Fenton reactions and culminates in lipid peroxidation (LPO), has emerged as a focal point in multiple tumors and neurodegenerative diseases. Researches show that iron homeostasis play critical roles in the optic nerve (ON) and retinal ganglion cells (RGCs), suggesting targeted treatments could be effective. In glaucoma, apart from neural lesions, disrupted metal balance and increased oxidative stress in trabecular meshwork (TM) are observed. These disturbances lead to extracellular matrix excretion disorders, known as sclerotic mechanisms, resulting in refractory blockages. Importantly, oxidative stress, a significant downstream effect of ferroptosis, is also a key factor in cell senescence. It plays a crucial role in both the etiology and risk of glaucoma. Moreover, ferroptosis also induces non-infectious inflammation, which exacerbate glaucomatous injury. Therefore, the relevance of ferroptosis in glaucoma is extensive and multifaceted. In this review, the study delves into the current understanding of ferroptosis mechanisms in glaucoma, aiming to provide clues to inform clinical therapeutic practices.
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Affiliation(s)
- Jingyun Zhu
- Department of Ophthalmology, Nanfang Hospital, Southern Medical University, No.1023-1063, Shatai South Road, Baiyun District, Guangzhou, Guangdong, 510515, China
| | - Hui Chen
- Department of Geriatrics, Hospital of Traditional Chinese Medicine Affiliated to Southwest Medical University, No.182, Chunhui Road, Longmatan District, Luzhou, Sichuan, 646000, China
| | - Jian Wu
- Department of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, No. 8, East Chongwenmennei Street, Dongcheng District, Beijing, 100005, China
| | - Sen Li
- Department of Spinal Surgery, Drum Tower Hospital, Nanjing University, No. 321 Zhongshan Road, Gulou District, Nanjing, Jiangsu, 210008, China
| | - Wanying Lin
- Department of Ophthalmology, Nanfang Hospital, Southern Medical University, No.1023-1063, Shatai South Road, Baiyun District, Guangzhou, Guangdong, 510515, China
| | - Ningli Wang
- Department of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, No. 8, East Chongwenmennei Street, Dongcheng District, Beijing, 100005, China
| | - Lang Bai
- Department of Ophthalmology, Nanfang Hospital, Southern Medical University, No.1023-1063, Shatai South Road, Baiyun District, Guangzhou, Guangdong, 510515, China
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Jing L, Liu K, Wang F, Su Y. Role of mechanically-sensitive cation channels Piezo1 and TRPV4 in trabecular meshwork cell mechanotransduction. Hum Cell 2024; 37:394-407. [PMID: 38316716 DOI: 10.1007/s13577-024-01035-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 01/17/2024] [Indexed: 02/07/2024]
Abstract
Glaucoma is one of the leading causes of irreversible blindness in developed countries, and intraocular pressure (IOP) is primary and only treatable risk factor, suggesting that to a significant extent, glaucoma is a disease of IOP disorder and pathological mechanotransduction. IOP-lowering ways are limited to decreaseing aqueous humour (AH) production or increasing the uveoscleral outflow pathway. Still, therapeutic approaches have been lacking to control IOP by enhancing the trabecular meshwork (TM) pathway. Trabecular meshwork cells (TMCs) have endothelial and myofibroblast properties and are responsible for the renewal of the extracellular matrix (ECM). Mechanosensitive cation channels, including Piezo1 and TRPV4, are abundantly expressed in primary TMCs and trigger mechanostress-dependent ECM and cytoskeletal remodelling. However, prolonged mechanical stimulation severely affects cellular biosynthesis through TMC mechanotransduction, including signaling, gene expression, ECM remodelling, and cytoskeletal structural changes, involving outflow facilities and elevating IOP. As for the functional coupling relationship between Piezo1 and TRPV4 channels, inspired by VECs and osteoblasts, we hypothesized that Piezo1 may also act upstream of TRPV4 in glaucomatous TM tissue, mediating the activation of TRPV4 via Ca2+ inflow or Ca2+ binding to phospholipase A2(PLA2), and thus be involved in increasing TM outflow resistance and elevated IOP. Therefore, this review aims to help identify new potential targets for IOP stabilization in ocular hypertension and primary open-angle glaucoma by understanding the mechanical transduction mechanisms associated with the development of glaucoma and may provide ideas into novel treatments for preventing the progression of glaucoma by targeting mechanotransduction.
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Affiliation(s)
- Lingling Jing
- Department of Ophthalmology, The Fourth Affiliated Hospital, Harbin Medical University, Harbin, China
| | - Kexin Liu
- Department of Ophthalmology, The Fourth Affiliated Hospital, Harbin Medical University, Harbin, China
| | - Feng Wang
- Department of Ophthalmology, The Fourth Affiliated Hospital, Harbin Medical University, Harbin, China.
| | - Ying Su
- Eye Hospital, The First Affiliated Hospital, Harbin Medical University, Harbin, China.
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Selective laser trabeculoplasty is safe and effective in patients previously treated with prostaglandin analogs: An evidence-based review. Int Ophthalmol 2023; 43:677-695. [PMID: 35962295 DOI: 10.1007/s10792-022-02460-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 07/31/2022] [Indexed: 10/15/2022]
Abstract
PURPOSE Prostaglandin analogs (PGAs) are first-line treatments for ocular hypertension (OHT) and open-angle glaucoma (OAG). However, frequent side effects and high costs hinder patient's compliance resulting in disease progression. Evidence suggests selective laser trabeculoplasty (SLT) may be considered a first-line treatment for OHT and OAG due to its safety profile, minor side effects, and reduced costs. Considering that PGAs and SLT share action mechanisms, it is hypothesized that previous PGA therapy may affect subsequent SLT efficacy. Therefore, we analyzed if PGAs reduce SLT efficacy. METHODS An evidence-based review was performed to assess the safety and efficacy of SLT in patients previously treated with PGAs. For this purpose, we performed an extensive literature search using the National Library of Medicine's PubMed and Google Scholar database for all English language articles published until May 2021. RESULTS There is evidence of non-superiority of PGAs therapy versus SLT for OHT and OAG. A multicenter, randomized, observer-masked clinical trial (RCT) of untreated OHT and OAG patients concluded that SLT should be offered as the first-line treatment for these patients. This study was supported by a meta-analysis of RCTs, comparing SLT efficacy versus antiglaucoma drugs only, with the advantage of an SLT lower rate of adverse effects. CONCLUSIONS Cost-effectiveness, patient compliance, and antiglaucoma drugs' side effects, including higher surgical failure, favor consideration of SLT as first-line therapy for OAG and OHT. Furthermore, SLT efficacy does not seem to be affected by prior PGA administration; however, larger cohort, comparative, multicenter RCTs are necessary to answer this question.
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Phillips SS, Patnaik JL, Capitena Young CE, Ertel MK, SooHoo JR, Seibold LK, Kahook MY, Pantcheva MB. Selective Laser Trabeculoplasty and Outcomes of Subsequent Phacoemulsification Combined with Kahook Dual Blade Goniotomy. Ophthalmol Ther 2022; 11:1883-1893. [PMID: 35922711 PMCID: PMC9437157 DOI: 10.1007/s40123-022-00554-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 07/22/2022] [Indexed: 11/26/2022] Open
Abstract
Introduction To investigate the relationship between intraocular pressure (IOP)-lowering success of selective laser trabeculoplasty (SLT) and combined phacoemulsification/Kahook Dual Blade (phaco/KDB) goniotomy in eyes with mild to severe open angle glaucoma (OAG). Methods Eyes undergoing combined phaco/KDB goniotomy and that had previously undergone SLT were analyzed. Data collected included demographics, glaucoma type and severity, IOP, and topical IOP-lowering medications before and after both procedures. Eyes were divided into two groups based on success of SLT, defined as IOP reduction of at least 20% maintained on at least two consecutive follow-up visits without any subsequent medication additions or interventions. Phaco/KDB goniotomy success was defined as IOP reduction of at least 20% and/or reduction in the number of IOP-lowering medications of at least one up to 12 months of follow-up. Results Overall, SLT was successful in 20 of 43 eyes (46.5%), of which 63.6% (7/11) had successful phaco/KDB goniotomy at 12 months follow-up. Among eyes with unsuccessful SLT, 60.0% (9/15) had successful phaco/KDB at 12 months follow-up. Phaco/KDB success rate was similar in patients regardless of their previous response to SLT at all postoperative time points up to 12 months follow-up (p = 0.87). Conclusions The presence or lack of IOP-lowering response to SLT did not influence the success rate of subsequent phaco/KDB goniotomy in eyes with mild to severe OAG. Patients who did not respond to SLT still benefited from phaco/KDB goniotomy at a later date.
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Affiliation(s)
- Stephen S Phillips
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, CO, USA.
- Sue Anschutz-Rodgers Eye Center, 1675 Aurora Court, Aurora, CO, 80045, USA.
| | - Jennifer L Patnaik
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Cara E Capitena Young
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Monica K Ertel
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Jeffrey R SooHoo
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Leonard K Seibold
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Malik Y Kahook
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Mina B Pantcheva
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, CO, USA
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Sarenac T, Bečić Turkanović A, Ferme P, Gračner T. A Review of Selective Laser Trabeculoplasty: “The Hype Is Real”. J Clin Med 2022; 11:jcm11133879. [PMID: 35807163 PMCID: PMC9267824 DOI: 10.3390/jcm11133879] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 06/28/2022] [Accepted: 06/29/2022] [Indexed: 12/10/2022] Open
Abstract
Presently, there is no efficacious treatment for glaucomatous optic neuropathy; the current treatment is focused on lowering intraocular pressure (IOP). Studies have demonstrated the safety and efficacy of selective laser trabeculoplasty (SLT) in reducing the IOP in eyes with open-angle (OAG) glaucoma or ocular hypertension (OH). Moreover, the European Glaucoma Society has instated SLT as the first-line or adjunctive treatment in OAG or OH, reiterating its clinical significance. In this review, we outline the old and the new roles of SLT, with an emphasis on clinical practice, and look further into its renewed appeal and future developments.
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Affiliation(s)
- Tomislav Sarenac
- Department of Ophthalmology, University Medical Center Maribor, Ljubljanska 5, 2000 Maribor, Slovenia; (T.S.); (A.B.T.); (P.F.)
- Faculty of Medicine, University of Maribor, Taborska Ulica 8, 2000 Maribor, Slovenia
| | - Anela Bečić Turkanović
- Department of Ophthalmology, University Medical Center Maribor, Ljubljanska 5, 2000 Maribor, Slovenia; (T.S.); (A.B.T.); (P.F.)
| | - Peter Ferme
- Department of Ophthalmology, University Medical Center Maribor, Ljubljanska 5, 2000 Maribor, Slovenia; (T.S.); (A.B.T.); (P.F.)
| | - Tomaž Gračner
- Department of Ophthalmology, University Medical Center Maribor, Ljubljanska 5, 2000 Maribor, Slovenia; (T.S.); (A.B.T.); (P.F.)
- Faculty of Medicine, University of Maribor, Taborska Ulica 8, 2000 Maribor, Slovenia
- Correspondence:
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Shimizu S, Honjo M, Sugimoto K, Okamoto M, Aihara M. Effect of pigmentation intensity of trabecular meshwork cells on mechanisms of micropulse laser trabeculoplasty. Sci Rep 2022; 12:10535. [PMID: 35732689 PMCID: PMC9217947 DOI: 10.1038/s41598-022-14637-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 06/09/2022] [Indexed: 11/22/2022] Open
Abstract
The intraocular pressure (IOP)-lowering mechanisms of micropulse laser trabeculoplasty (MLT) remain unclear. The present study was performed to investigate the mechanism of action of MLT, and to determine whether the pigmentation intensity of trabecular meshwork (TM) cells is associated with the treatment effects. Primary human TM cells were exposed to melanin granules to artificially introduce different levels of pigmentation. Micropulse (MP) laser irradiation was performed, and interleukin (IL)-1α/β, matrix metalloproteinases (MMPs), tissue inhibitor of metalloproteinases (TIMPs), and extracellular matrix (ECM) protein expression were evaluated by RT-qPCR and immunocytochemistry. IL-1α/β and MMP-1, -3, and -9 mRNA expression were significantly upregulated at 4 and 24 h after MP laser irradiation, respectively, but there were no significant changes in TIMP expression. The extent of these upregulation was greater in cells with strong pigmentation intensity. Protein expressions of fibronectin and collagen I were significantly decreased in cells with strong staining intensity. These results suggested that MP laser irradiation alter the MMP/TIMP ratio and enhance ECM turnover, resulting in increased outflow of aqueous humor. The pigmentation intensity of the TM tissues may affect the treatment efficacy of MLT, because TM cells with strong staining intensity showed a significantly enhanced response to MP laser irradiation.
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Affiliation(s)
- Shota Shimizu
- Department of Ophthalmology, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Megumi Honjo
- Department of Ophthalmology, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
| | - Koichiro Sugimoto
- Department of Ophthalmology, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | | | - Makoto Aihara
- Department of Ophthalmology, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
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Gupta M, Heo JY, Gong H, Cha E, Latina M, Rhee DJ. Morphologic and Cellular Changes Induced by Selective Laser Trabeculoplasty. Clin Ophthalmol 2022; 16:1383-1390. [PMID: 35520109 PMCID: PMC9064177 DOI: 10.2147/opth.s342787] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Accepted: 12/24/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose Selective laser trabeculoplasty is a safe and effective procedure for reducing IOP, but its mechanism of action is not fully elucidated. We evaluated the morphologic and cellular changes as well as DNA synthesis after SLT treatment of human trabecular meshwork (TM) tissue explants. Methods Corneoscleral rim tissues that underwent SLT treatment were compared to control segments that had no laser treatment. Light microscopy (LM), transmission electron microscopy (TEM), and scanning electron microscopy (SEM) were used to assess cell morphology. The Click-iT 5-ethynyl-2'-deoxyuridine (EdU) imaging kit was used to compare DNA synthesis/cell proliferation with a confocal microscope. All tissues were assessed for vitality. Results SLT treatment does not reveal notable cell damage in the juxtacanalicular (JCT) region, but mildly disrupts superficial trabecular beams and uveal TM, ablates TM endothelial cells from the undamaged beams as detected by both LM and TEM. This superficial destruction was not observed in some SLT treatment spots on higher magnification by SEM. SLT treatment increased mitotic activity and DNA synthesis near the lining of Schlemm's canal after several days. Conclusion SLT treatment disrupts endothelial cells in the corneoscleral TM and causes superficial ultrastructural changes to the uveal TM. SLT treatment also shows a trend towards dynamic time-dependent changes in (DNA synthesis) with an increase in mitotic activity at 7 days cell proliferation.
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Affiliation(s)
- Meenakashi Gupta
- Department of Ophthalmology, New York Eye & Ear Infirmary of Mt. Sinai, New York, NY, USA
| | - Jae Young Heo
- Department of Ophthalmology & Visual Sciences, University Hospitals, Cleveland, OH, USA
| | - Haiyan Gong
- Department of Ophthalmology, Boston University, Boston, MA, USA
| | - Elliot Cha
- Department of Ophthalmology, Boston University, Boston, MA, USA
| | - Mark Latina
- Department of Ophthalmology, Massachusetts Eye & Ear Infirmary, Boston, MA, USA,Department of Ophthalmology, Advanced Glaucoma Specialists, Reading, MA, USA
| | - Douglas J Rhee
- Department of Ophthalmology & Visual Sciences, University Hospitals, Cleveland, OH, USA,Correspondence: Douglas J Rhee, Department of Ophthalmology & Visual Sciences, 10900 Euclid Ave, Lakeside, 4129, Cleveland, OH, 44105, USA, Tel +1 216-844-8590, Fax +1 216-983-0544, Email
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Gillmann K, Rao HL, Mansouri K. Changes in peripapillary and macular vascular density after laser selective trabeculoplasty: an optical coherence tomography angiography study. Acta Ophthalmol 2022; 100:203-211. [PMID: 33629531 DOI: 10.1111/aos.14805] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 02/02/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To determine the effect of laser trabeculoplasty on peripapillary retinal nerve fibre layer thickness (RNFL), fovea avascular zone (FAZ), peripapillary and macular vessel density (VD) in glaucoma using with optical coherence tomography angiography (OCT-A). METHODS This was a prospective observational study performed at the Glaucoma Research Centre, Montchoisi Clinic, Lausanne, Switzerland. Thirty-seven eyes with primary open-angle glaucoma from 21 patients were included. Optical coherence tomography angiography (OCT-A) scans were performed before laser trabeculoplasty and at 2 and 6 months after the procedure. AngioVue AngioAnalytic (Optovue Inc, Fremont, CA, USA) software was used to analyse the RNFL, FAZ, peripapillary and macular VD. Changes were analysed using mixed models, controlling for intraocular pressure (IOP) and signal strength index (SSI) variations. RESULTS Mean IOP decreased from 18.5 (±3.7) mmHg at baseline to 15.6 (±2.7) mmHg after 2 months (-15.3%; p < 0.001). No significant changes in RNFL thickness were noted following laser trabeculoplasty. Changes in peripapillary VD were mostly nonsignificant. Parafoveal (p = 0.001) and perifoveal VD (p = 0.025) significantly increased at 2 months, before reverting to near-baseline values at 6 months. No significant changes were observed in foveal parameters. Retinal nerve fibre layer thickness (RNFL) and VD changes were independent from IOP, but SSI had a significant influence on VD. CONCLUSIONS Following laser trabeculoplasty, peripapillary and macular VD temporarily increased before returning to near-baseline values by 6 months. No correlation was found between microvascular fluctuations and IOP, and no significant effect of laser trabeculoplasty on VD or RNFL was observed at 6 months despite persistent IOP reduction. Further research is warranted to understand its exact causes and clinical relevance.
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Affiliation(s)
- Kevin Gillmann
- Glaucoma Research Center Montchoisi Clinic Swiss Visio Lausanne Switzerland
| | | | - Kaweh Mansouri
- Glaucoma Research Center Montchoisi Clinic Swiss Visio Lausanne Switzerland
- Department of Ophthalmology University of Colorado School of Medicine Denver CO USA
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Gack C, Laemmer R, Hohberger B. Five-Year Long-Term Follow-Up of Selective Laser Trabeculoplasty in Open-Angle Glaucoma. Klin Monbl Augenheilkd 2021; 239:1239-1244. [PMID: 34921359 DOI: 10.1055/a-1668-0145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE Selective laser trabeculoplasty (SLT) is known as a safe laser therapy for an effective reduction in intraocular pressure (IOP). The aim of this study was to examine the therapeutic success of SLT in open-angle glaucoma (OAG) patients with a long-term follow-up of 5 years. METHODS Forty-six eyes of forty OAG patients, some with previous intraocular surgery, underwent SLT (24 males, 16 females). Therapeutic success was categorized as: category (I) - IOP reduction ≤ 21 mmHg and > 20% compared to baseline IOP with additional glaucoma medication; category (II) - IOP reduction ≤ 18 mmHg and > 30% compared to baseline IOP with additional glaucoma medication; category (III) - IOP reduction ≤ 18 mmHg without any additional glaucoma medication at all follow-ups. Therapeutic failure was defined as the necessity of any further glaucoma surgery (IV). RESULTS (1) SLT was well tolerated in all eyes, and no severe side effects or complications were recorded. (2) After 1-year follow-up, therapeutic success was 27% (I), 30% (II), and 3% (III). The therapeutic failure rate was 40% (IV). (3) After 2 years follow-up, therapeutic success was 7% (I), 10% (II), and 0% (III). The therapeutic failure rate was 83% (IV). (4) After 3 years follow-up, the therapeutic failure rate increased up to 100% (IV). CONCLUSION SLT seemed to be effective in lowering IOP in the first year in the present cohort, however, the long-term effect is low and additional local therapy or surgical interventions are necessary.
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Affiliation(s)
- Christina Gack
- Augenklinik, Universitätsklinikum Erlangen, Erlangen, Germany
| | - Robert Laemmer
- Augenklinik, Universitätsklinikum Erlangen, Erlangen, Germany
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Chen YS, Hung HT, Guo SP, Chang HC. Effects of anti-inflammatory treatment on efficacy of selective laser trabeculoplasty: a systematic review and meta-analysis. Expert Rev Clin Pharmacol 2021; 14:1527-1534. [PMID: 34524035 DOI: 10.1080/17512433.2021.1981860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Selective laser trabeculoplasty (SLT) can evidently reduce intraocular pressure (IOP) in cases of open-angle glaucoma. Several studies have investigated the effectiveness of anti-inflammatory treatment to relieve discomfort after SLT, but whether such treatments affect the response of SLT remains uncertain. METHODS We systematically searched PubMed, Embase, Web of Science, and Cochrane Library for relevant studies published before 31 March 2021. The major outcomes were the efficacy of post-SLT anti-inflammatory treatment on IOP reduction, incidence of discomfort, and anterior chamber inflammation compared with those of placebo agents. RESULTS Five randomized controlled trials with 235 eyes receiving anti-inflammatory treatment and 170 eyes receiving placebo agents were included in the meta-analysis. Compared with placebo, no significant differences were present in IOP reduction effects upon using topical non-steroidal anti-inflammatory drugs or steroid post-SLT. The results were consistent from 1 to 6 months during follow-up. Furthermore, anti-inflammatory treatment had no significant effects on pain or discomfort or the presence of anterior chamber cells 1 h to 1 week post-SLT. CONCLUSION Topical anti-inflammatory treatment after SLT for patients with glaucoma neither significantly affected IOP reduction nor remarkably relieved clinical discomfort and anterior chamber inflammation. Hence, regular use of post-SLT anti-inflammatory treatment may be unnecessary.
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Affiliation(s)
- Yu-Sheng Chen
- School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Hai-Ting Hung
- School of Dentistry, College of Oral Medicine, Taipei Medical University, Taipei, Taiwan
| | - Siao-Pei Guo
- Department of Ophthalmology, Taipei Medical University Hospital, Taipei, Taiwan
| | - Hua-Ching Chang
- Department of Dermatology, Taipei Medical University Hospital, Taipei, Taiwan.,Research Center of Big Data and Meta-Analysis, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
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Gračner T. Impact of Short-Term Topical Steroid Therapy on Selective Laser Trabeculoplasty Efficacy. J Clin Med 2021; 10:jcm10184249. [PMID: 34575360 PMCID: PMC8472338 DOI: 10.3390/jcm10184249] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 09/12/2021] [Accepted: 09/16/2021] [Indexed: 11/16/2022] Open
Abstract
Background: To evaluate whether short-term use of topical steroid therapy affected the efficacy of selective laser trabeculoplasty (SLT) for primary open-glaucoma (POAG). Methods: 25 eyes of 25 patients, who used a drop of dexamethasone 0.1% 4 times a day for 7 days as post-laser therapy, formed the Steroid SLT group and 24 eyes of 24 patients, where no topical steroids or nonsteroidal anti-inflammatory agents as post-laser therapy were used, formed the No-steroid SLT group. Success was defined as an intraocular pressure (IOP) lowering exceeding 20% of pretreatment IOP. Results: The mean follow-up time was 21.24 months for the Steroid SLT group and 20.25 months for the No-steroid SLT group (p = 0.990). No significant difference was found between the two groups for mean pretreatment IOP (22.20 mmHg vs. 22.33 mmHg), and for mean IOP reductions during whole follow-up period. At all follow-up visits, the mean IOP reductions were smaller in the Steroid SLT group than in the No-steroid SLT group. At all follow-up visits, the mean percent IOP reduction was smaller in the Steroid SLT group than in the No-steroid SLT group, and such a difference was significant at 12 months (25.4% vs. 29.6%, p = 0.047) and 24 months (25.3% vs. 29.7%, p = 0.024). According to the Kaplan–Meier survival analysis, the 24-month success rate was 84% in the Steroid SLT group and 79.2% in the No-steroid SLT group, with no differences between the groups (p = 0.675). Conclusion: Short-term use of topical steroid therapy had no impact on the efficacy of SLT for POAG.
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Affiliation(s)
- Tomaž Gračner
- Faculty of Medicine, University of Maribor, 2000 Maribor, Slovenia; ; Tel.: +386-40-522765; Fax: +386-23-312393
- Department of Ophthalmology, University Clinical Centre Maribor, 2000 Maribor, Slovenia
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Efficacy of Selective Laser Trabeculoplasty after iStent Implantation in Primary Open-Angle Glaucoma. J Pers Med 2021; 11:jpm11080797. [PMID: 34442441 PMCID: PMC8400945 DOI: 10.3390/jpm11080797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 07/31/2021] [Accepted: 08/13/2021] [Indexed: 11/17/2022] Open
Abstract
iStent implantation is thought to augment the trabecular outflow channel in the anterior segment of the eye. We hypothesized that iStent with subsequent selective laser trabeculoplasty (SLT) would better control the intraocular pressure (IOP) compared to standalone SLT in patients with primary open-angle glaucoma (POAG). We, therefore, determined if the presence of an iStent combined with SLT was statistically associated with IOP lowering compared to standalone SLT. Through retrospective electronic medical record review, records of 824 eyes from 440 patients who received primary SLT without a history of iStent were considered. Additionally, 42 eyes from 28 patients who received SLT after combined phacoemulsification and iStent implantation that failed to control intraocular pressure (IOP) and/or the progression of the disease were retrospectively reviewed. IOP and number of medications, which were tracked in each patient for up to 12 months post laser, were also examined. Successful outcome was defined as a statistically significant reduction in IOP or number of medications at 6 months. As defined in univariate analysis (p ≤ 0.01), multivariate analysis included iStent, age, sex, race, and initial IOP as variables. IOP reduction was statistically associated with patients pre-SLT IOP (p < 0.001) but not with patients with iStent (p = 0.222). Medication reduction was statistically associated with the pre-SLT number of medications (p < 0.001) and iStent (p < 0.001). In eyes that received SLT, iStent was not statistically associated with a greater reduction in IOP compared to controls, but was associated with a higher reduction in the overall number of medications used 6 months after receiving SLT. The work presented should guide clinicians to consider SLT as an effective therapy after iStent implantation, in terms of glaucoma medication reduction in iStent patients, but clinicians should know that the presence of an iStent does not necessarily make subsequent SLT more effective at lowering IOP.
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Landers J. Selective laser trabeculoplasty: A review. Clin Exp Ophthalmol 2021; 49:1102-1110. [PMID: 34331388 DOI: 10.1111/ceo.13979] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 07/09/2021] [Accepted: 07/15/2021] [Indexed: 11/24/2022]
Abstract
Glaucoma is the second most prevalent cause of blindness worldwide, and the only effective management is the lowering of intraocular pressure (IOP). Selective laser trabeculoplasty (SLT) has become an essential part of glaucoma management since its commercial release in 2001. It has been an improvement from the previous argon laser trabeculoplasty (ALT), by using 1% of the laser energy, reducing the amount of anterior segment inflammation and minimising the degree of mechanical injury to the trabecular meshwork. There is now a large volume of work that demonstrates SLT is equally effective as ALT and topical medication in lowering IOP. It is simple to perform, with a well described side-effect profile, and is long-lasting and repeatable. This review will summarise the current literature on SLT for each of these topics.
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Affiliation(s)
- John Landers
- Department of Ophthalmology, Flinders Medical Centre, Adelaide, South Australia, Australia
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Zgryźniak A, Przeździecka-Dołyk J, Szaliński M, Turno-Kręcicka A. Selective Laser Trabeculoplasty in the Treatment of Ocular Hypertension and Open-Angle Glaucoma: Clinical Review. J Clin Med 2021; 10:jcm10153307. [PMID: 34362091 PMCID: PMC8347751 DOI: 10.3390/jcm10153307] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 07/22/2021] [Accepted: 07/23/2021] [Indexed: 11/16/2022] Open
Abstract
Selective laser trabeculoplasty (SLT) is a glaucoma treatment that reduces intraocular pressure (IOP). Its mechanism is based on the biological effects of the selective application of laser energy to pigmented trabecular meshwork (TM) cells, resulting in increased outflow facility. Herein, we review current publications on SLT and summarize its efficacy and safety for different indications in open-angle glaucoma (OAG) and ocular hypertension (OHT) treatment. SLT effectively reduces IOP when used as a primary treatment. In patients whose IOP is medically controlled, SLT helps to reduce medication use, and when maximally tolerated topical therapy is ineffective, SLT facilitates the realization of the target IOP. SLT is a repeatable procedure for which the vast majority of complications are mild and self-limiting. With effective IOP reduction, low complication rates and the potential to repeat the procedure, SLT offers the possibility of delaying the introduction of medical therapy and other more invasive treatment modalities while simultaneously avoiding the accompanying complications. With this knowledge, we suggest that SLT be considered as an essential primary treatment option in OAG and OHT, switching to other treatment modalities only when laser procedures are insufficient for achieving the required target IOP.
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Affiliation(s)
- Aleksandra Zgryźniak
- Clinic of Ophthalmology, University Teaching Hospital, ul. Borowska 213, 50-556 Wroclaw, Poland; (A.Z.); (M.S.); (A.T.-K.)
| | - Joanna Przeździecka-Dołyk
- Department of Optics and Photonics, Wroclaw University of Science and Technology, wyb. Stanislawa Wyspianskiego 27, 50-370 Wroclaw, Poland
- Department of Ophthalmology, Wroclaw Medical University, ul. Borowska 213, 50-556 Wroclaw, Poland
- Correspondence: or
| | - Marek Szaliński
- Clinic of Ophthalmology, University Teaching Hospital, ul. Borowska 213, 50-556 Wroclaw, Poland; (A.Z.); (M.S.); (A.T.-K.)
- Department of Ophthalmology, Wroclaw Medical University, ul. Borowska 213, 50-556 Wroclaw, Poland
| | - Anna Turno-Kręcicka
- Clinic of Ophthalmology, University Teaching Hospital, ul. Borowska 213, 50-556 Wroclaw, Poland; (A.Z.); (M.S.); (A.T.-K.)
- Department of Ophthalmology, Wroclaw Medical University, ul. Borowska 213, 50-556 Wroclaw, Poland
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Lee J, Choi JA, Ju HH, Kim JE, Paik SY, Rao PV. Role of MCP-1 and IL-8 in viral anterior uveitis, and contractility and fibrogenic activity of trabecular meshwork cells. Sci Rep 2021; 11:14950. [PMID: 34294770 PMCID: PMC8298573 DOI: 10.1038/s41598-021-94391-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 07/08/2021] [Indexed: 12/02/2022] Open
Abstract
The inflammatory chemokines, monocyte chemoattractant protein (MCP)-1 and IL-8, are produced by normal trabecular meshwork cells (TM) and elevated in the aqueous humor of primary open angle glaucoma (POAG) and hypertensive anterior uveitis associated with viral infection. However, their role in TM cells and aqueous humor outflow remains unclear. Here, we explored the possible involvement of MCP-1 and IL-8 in the physiology of TM cells in the context of aqueous outflow, and the viral anterior uveitis. We found that the stimulation of human TM cells with MCP-1 and IL-8 induced significant increase in the formation of actin stress fibers and focal adhesions, myosin light chain phosphorylation, and the contraction of TM cells. MCP-1 and IL-8 also demonstrated elevation of extracellular matrix proteins, and the migration of TM cells. When TM cells were infected with HSV-1 and CMV virus, there was a significant increase in cytoskeletal contraction and Rho-GTPase activation. Viral infection of TM cells revealed significantly increased expression of MCP-1 and IL-8. Taken together, these results indicate that MCP-1 and IL-8 induce TM cell contractibility, fibrogenic activity, and plasticity, which are presumed to increase resistance to aqueous outflow in viral anterior uveitis and POAG.
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Affiliation(s)
- Jiyoung Lee
- Department of Ophthalmology and Visual Science, College of Medicine, St. Vincent's Hospital, The Catholic University of Korea, Banpo-daero 222, Seocho-gu, Seoul, 137-701, Republic of Korea
| | - Jin A Choi
- Department of Ophthalmology and Visual Science, College of Medicine, St. Vincent's Hospital, The Catholic University of Korea, Banpo-daero 222, Seocho-gu, Seoul, 137-701, Republic of Korea.
- Department of Ophthalmology, Duke University School of Medicine, Durham, NC, USA.
| | - Hyun-Hee Ju
- Department of Ophthalmology and Visual Science, College of Medicine, St. Vincent's Hospital, The Catholic University of Korea, Banpo-daero 222, Seocho-gu, Seoul, 137-701, Republic of Korea
| | - Ju-Eun Kim
- Department of Microbiology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Soon-Young Paik
- Department of Microbiology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Ponugoti Vasantha Rao
- Department of Ophthalmology, Duke University School of Medicine, Durham, NC, USA
- Department of Pharmacology and Cancer Biology, Duke University School of Medicine, Durham, NC, USA
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Realini T, Gazzard G, Latina M, Kass M. Low-energy Selective Laser Trabeculoplasty Repeated Annually: Rationale for the COAST Trial. J Glaucoma 2021; 30:545-551. [PMID: 33428350 PMCID: PMC8238780 DOI: 10.1097/ijg.0000000000001788] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 12/20/2020] [Indexed: 11/25/2022]
Abstract
The recent Laser in Glaucoma and Ocular Hypertension Trial provided the evidentiary basis for a paradigm shift away from the historical medication-first approach to glaucoma--which has numerous limitations, the most important of which is poor adherence to therapy --and toward a laser-first approach. Now 20 years after its commercialization, selective laser trabeculoplasty (SLT) is routinely performed consistently with its initial description, with energy titrated to the appearance of fine, champagne-like cavitation bubbles. A recent data set suggested that lower energy SLT, applied as primary therapy and repeated annually irrespective of intraocular pressure--rather than pro re nata when its effect wanes and irrespective of intraocular pressure rises --yields longer medication-free survival than standard energy SLT repeated pro re nata. A new study--Clarifying the Optimal Application of SLT Therapy --has been initiated to explore this preliminary finding in a pair of consecutive randomized trials. Herein, we provide an evidence-based rationale for the use of low-energy SLT repeated annually as primary therapy for mild to moderate primary open-angle glaucoma or high-risk ocular hypertension.
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Affiliation(s)
- Tony Realini
- Department of Ophthalmology and Visual Sciences, West Virginia University, Morgantown, WV
| | - Gus Gazzard
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust, London, UK; University College London, UK
| | - Mark Latina
- Department of Ophthalmology, Tufts University, Boston, MA
| | - Michael Kass
- Department of Ophthalmology and Visual Sciences, Washington University, St. Louis, MO
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AlObaida I, Al Owaifeer AM, Alotaibi H, Alsafi A, Ali Aljasim L. Outcomes of selective laser trabeculoplasty in corticosteroid-induced ocular hypertension and glaucoma. Eur J Ophthalmol 2021; 32:1525-1529. [PMID: 34096363 DOI: 10.1177/11206721211023310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To report the outcomes of selective laser trabeculoplasty (SLT) in lowering intraocular pressure (IOP) in patients with steroid-induced ocular hypertension and glaucoma. METHODS A retrospective chart review of patients who underwent SLT for steroid-induced ocular hypertension or glaucoma between January 2014 and October 2018. Success of SLT was defined as ⩾20% IOP reduction from baseline without further medical or surgical intervention and/or a reduction in the number of glaucoma medications by ⩾1 from baseline while maintaining the target IOP. Main outcome measures were change in IOP from baseline and reduction in the number of medications post-laser. RESULTS A total of 25 eyes of 17 patients were included in the study. The mean duration of follow-up was 18.8 ± 4.5 months. IOP decreased from 23.7 ± 6.7 mmHg pre-laser to 14.4 ± 3.2 mmHg post-laser, at the last follow-up visit (p < 0.001). The mean number of medications was 1.8 ± 1.6 medications pre-laser and 1.4 ± 1.3 medications post-laser (p = 0.262). The overall success rate at 12 months was 72%. No visually significant complications were encountered during the whole duration of follow-up. CONCLUSION SLT is a safe and effective procedure that can result in well-controlled IOP in patients with steroid-induced ocular hypertension and glaucoma.
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Affiliation(s)
| | - Adi Mohammed Al Owaifeer
- King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia.,Ophthalmology Unit, Department of Surgery, College of Medicine, King Faisal University, Al-Ahsa, Eastern Province, Saudi Arabia
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King J, Lee D, Thomsen S, Hirabayashi MT, An J. Relationship between selective laser trabeculoplasty and excisional goniotomy outcomes in glaucomatous eyes. CANADIAN JOURNAL OF OPHTHALMOLOGY 2021; 57:112-117. [PMID: 33839069 DOI: 10.1016/j.jcjo.2021.02.040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 02/17/2021] [Accepted: 02/27/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To evaluate the relationship between intraocular pressure (IOP)-lowering success with selective laser trabeculoplasty (SLT) and Kahook Dual Blade (KDB) goniotomy in eyes with glaucoma. DESIGN Retrospective chart review. PARTICIPANTS 30 eyes of 24 patients undergoing phacoemulsification combined with a KDB with 6 months follow-up and who had previously undergone SLT in the same eye. METHODS Data collected from electronic health records included demographic and glaucoma status, IOP and IOP-lowering medication after SLT and KDB. SLT and KDB success were defined as IOP reduction ≥20% or medication reduction ≥1 at 2 and 6 months, respectively. MAIN OUTCOME Association between SLT success and KDB success. RESULTS Overall, SLT was successful in 17 of 30 eyes (56.7%) at 2 months, and KDB was successful in 18 of 30 eyes (60%) at 6 months. Nine of 17 eyes (52.9%) with prior successful SLT had successful subsequent KDB, whereas 9 of 13 (69.2%) with prior unsuccessful SLT had successful KDB. There was no significant relationship between SLT and KDB outcome in these 30 eyes (p = 0.465 by Fisher's exact test). CONCLUSION No relationship between success of SLT and subsequent KDB was observed. However, patients with history of failed SLT still benefited from subsequent KDB.
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Affiliation(s)
- Joshua King
- University of Missouri, Columbia School of Medicine, Columbia, Mo
| | - Dayeong Lee
- University of Missouri, Columbia School of Medicine, Columbia, Mo
| | - Samuel Thomsen
- University of Missouri, University Eye Institute East, Columbia, Mo
| | | | - Jella An
- University of Missouri, Columbia School of Medicine, Columbia, Mo; University of Missouri, University Eye Institute East, Columbia, Mo.
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Wang P, Akkach S, Andrew NH, Wells AP. Selective Laser Trabeculoplasty: Outcomes of Multiple Repeat Treatments. Ophthalmol Glaucoma 2021; 4:482-489. [PMID: 33429110 DOI: 10.1016/j.ogla.2020.12.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 12/16/2020] [Accepted: 12/29/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE To characterize intraocular pressure (IOP) reduction, effect duration, and side effect profile of repeat selective laser trabeculoplasty (SLT) used as primary stand-alone treatment for open-angle glaucoma (OAG). The secondary aim was to investigate covariates associated with treatment response to SLT. DESIGN Retrospective chart review. PARTICIPANTS A total of 52 patients with treatment-naïve OAG who received 3 installments of 3600 SLT as stand-alone glaucoma therapy. When both eyes met the inclusion criteria, only right eye data were used for analysis. METHODS The study was conducted in a single specialist practice. First, second, and third SLT (SLT1, SLT2, SLT3, respectively) treatments were compared for IOP reduction and effect duration. Eyes were classified as "treatment responders" if they had ≥20% IOP reduction 4 to 8 weeks post-SLT compared with baseline. Effect duration was the interval between SLT and the time point at which the surgeon decided inadequate IOP control necessitated repeat SLT. Individuals were excluded if they underwent intraocular surgery during the study period or received treatment with adjunctive ocular hypotensive medications. MAIN OUTCOME MEASURES Reduction in IOP post-SLT and effect duration between treatments. RESULTS Mean age at SLT1 was 58 years; 50% were male, and 92% were phakic. The SLT1 and SLT3 both resulted in mean 27% IOP reduction at 4 to 8 weeks, whereas SLT2 led to 26% IOP reduction. Response rate (≥20% IOP reduction at 4-8 weeks) was 79% for SLT1, 73% for SLT2, and 81% for SLT3, but the difference was not statistically significant. Response to repeat SLT was not significantly associated with previous SLT outcome. Effect duration was 22.2 months, 33.8 months, and 28.9 months after SLT1, SLT2, and SLT3, respectively. Effect duration was significantly longer after SLT2 (P = 0.0006) and SLT3 (P = 0.0444) compared with SLT1. There was no significant association between SLT response and gender, lens status, or OAG subtype. CONCLUSIONS For primary stand-alone treatment in OAG, initial and repeat SLTs produced comparable percentage IOP reduction, but repeat SLTs had longer effect duration. Intraocular pressure response to SLT was not predictive of the IOP response to subsequent, repeat SLT treatment.
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Affiliation(s)
- Peiyun Wang
- Department of Ophthalmology, Capital and Coast DHB, Wellington, New Zealand.
| | - Sarmad Akkach
- Royal Victoria Eye and Ear Hospital, Melbourne, Australia
| | - Nicholas H Andrew
- Department of Ophthalmology, Capital and Coast DHB, Wellington, New Zealand; Capital Eye Specialists, Wellington, New Zealand
| | - Anthony P Wells
- Department of Ophthalmology, Capital and Coast DHB, Wellington, New Zealand; Capital Eye Specialists, Wellington, New Zealand
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Margeta MA, Letcher SM, Igo RP, Cooke Bailey JN, Pasquale LR, Haines JL, Butovsky O, Wiggs JL. Association of APOE With Primary Open-Angle Glaucoma Suggests a Protective Effect for APOE ε4. Invest Ophthalmol Vis Sci 2021; 61:3. [PMID: 32614373 PMCID: PMC7425753 DOI: 10.1167/iovs.61.8.3] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Purpose Prior studies have demonstrated that microglial activation is involved in the pathogenesis of primary open-angle glaucoma (POAG). Here we sought to identify genetic associations between POAG and variants in APOE and TREM2, genes associated with Alzheimer disease (AD) that critically regulate microglial neurodegeneration-associated molecular signature. Methods APOE genotypes were called using imputed data from the NEIGHBOR consortium (2120 POAG cases, 2262 controls) and a second cohort from the Massachusetts Eye and Ear Infirmary (MEEI; 486 cases, 344 controls). TREM2 coding variants were genotyped by means of the Illumina HumanExome BeadArray. The data set was analyzed for association with POAG overall, as well as the high-tension glaucoma (HTG) and normal-tension glaucoma (NTG) subgroups, using logistic regression adjusting for age and sex. Results In the combined NEIGHBOR-MEEI data set, significant association was observed for APOE ε4 in POAG overall (odds ratio [OR], 0.83; 95% confidence interval [CI], 0.74–0.94; P = 0.0022) and in both the HTG subgroup (OR, 0.81; 95% CI, 0.70–0.94; P = 0.0052) and NTG subgroup (OR, 0.71; 95% CI, 0.58–0.87; P = 0.0014). A rare TREM2 variant (A105V) was found only in HTG cases (3 of 2863 cases) and in none of the controls (P = 0.03). Three TREM2 rare variants associated with AD were not significantly associated with POAG (P > 0.05). Conclusions We have found that the APOE ε4 allele is associated with a reduced risk of POAG. Interestingly, the same allele is adversely associated with AD, suggesting a mechanistic difference between neurodegenerative diseases of the eye and the brain. TREM2 variants associated with AD did not significantly contribute to POAG risk.
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Maier AKB, Arani P, Pahlitzsch M, Davids AM, Pilger D, Klamann MKJ, Winterhalter S. Influence of Selective Laser Trabeculoplasty (SLT) on the iStent inject® outcomes. BMC Ophthalmol 2020; 20:457. [PMID: 33213403 PMCID: PMC7678109 DOI: 10.1186/s12886-020-01723-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 11/09/2020] [Indexed: 11/29/2022] Open
Abstract
Background To evaluate the influence of Selective Laser Trabeculoplasty (SLT) on iStent inject® outcomes in open-angle glaucoma (OAG). Methods In this retrospective comparative cohort outcome study, 66 patients who were treated with two iStent inject® devices were included. Patients were divided into two subgroups consisting of patients without SLT treatment prior to surgery and patients who had been treated previously with 360° SLT but without sufficient response. Outcome measures included intraocular pressure (IOP) and number of antiglaucoma medications after 6 weeks with three, six, 12, and 24 month follow-ups. Results Mean preoperative IOP decreased from 20.4 ± 5.3 mmHg to 14.8 ± 3.0 mmHg for patients without SLT treatment prior to surgery (p = 0.001) and from 19.2 ± 4.5 mmHg to 14.0 ± 1.6 mmHg for patients with insufficient response to 360° SLT treatment (p = 0.027) at 12 months after iStent inject® implantation. No significant difference was found between the two groups (p > 0.05). The number of antiglaucoma medications did not change in both groups (p > 0.05) and showed no significant difference between the two groups (p > 0.05). Conclusion Prior SLT treatment seems to have no negative influence on the IOP lowering-effect of iStent inject® implantation in patients with OAG. It is therefore an appropriate incremental procedure with no exclusion criterion for an iStent inject® implantation.
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Affiliation(s)
- Anna-Karina B Maier
- Department of Ophthalmology, Campus Virchow- Klinikum, Charité - University Medicine Berlin, corporate member of Freie Universität Berlin, Humboldt- Universität zu Berlin and Berlin Institute of Health, Berlin, Germany.
| | - Parisa Arani
- Department of Ophthalmology, Campus Virchow- Klinikum, Charité - University Medicine Berlin, corporate member of Freie Universität Berlin, Humboldt- Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Milena Pahlitzsch
- Department of Ophthalmology, Campus Virchow- Klinikum, Charité - University Medicine Berlin, corporate member of Freie Universität Berlin, Humboldt- Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Anja-Maria Davids
- Department of Ophthalmology, Campus Virchow- Klinikum, Charité - University Medicine Berlin, corporate member of Freie Universität Berlin, Humboldt- Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Daniel Pilger
- Department of Ophthalmology, Campus Virchow- Klinikum, Charité - University Medicine Berlin, corporate member of Freie Universität Berlin, Humboldt- Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Matthias K J Klamann
- Department of Ophthalmology, Campus Virchow- Klinikum, Charité - University Medicine Berlin, corporate member of Freie Universität Berlin, Humboldt- Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Sibylle Winterhalter
- Department of Ophthalmology, Campus Virchow- Klinikum, Charité - University Medicine Berlin, corporate member of Freie Universität Berlin, Humboldt- Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
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Baudouin C, Kolko M, Melik-Parsadaniantz S, Messmer EM. Inflammation in Glaucoma: From the back to the front of the eye, and beyond. Prog Retin Eye Res 2020; 83:100916. [PMID: 33075485 DOI: 10.1016/j.preteyeres.2020.100916] [Citation(s) in RCA: 161] [Impact Index Per Article: 40.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Revised: 10/09/2020] [Accepted: 10/13/2020] [Indexed: 02/08/2023]
Abstract
The pathophysiology of glaucoma is complex, multifactorial and not completely understood. Elevated intraocular pressure (IOP) and/or impaired retinal blood flow may cause initial optic nerve damage. In addition, age-related oxidative stress in the retina concurrently with chronic mechanical and vascular stress is crucial for the initiation of retinal neurodegeneration. Oxidative stress is closely related to cell senescence, mitochondrial dysfunction, excitotoxicity, and neuroinflammation, which are involved in glaucoma progression. Accumulating evidence from animal glaucoma models and from human ocular samples suggests a dysfunction of the para-inflammation in the retinal ganglion cell layer and the optic nerve head. Moreover, quite similar mechanisms in the anterior chamber could explain the trabecular meshwork dysfunction and the elevated IOP in primary open-angle glaucoma. On the other hand, ocular surface disease due to topical interventions is the most prominent and visible consequence of inflammation in glaucoma, with a negative impact on filtering surgery failure, topical treatment efficacy, and possibly on inflammation in the anterior segment. Consequently, glaucoma appears as an outstanding eye disease where inflammatory changes may be present to various extents and consequences along the eye structure, from the ocular surface to the posterior segment, and the visual pathway. Here we reviewed the inflammatory processes in all ocular structures in glaucoma from the back to the front of the eye and beyond. Our approach was to explain how para-inflammation is necessary to maintain homoeostasis, and to describe abnormal inflammatory findings observed in glaucomatous patients or in animal glaucoma models, supporting the hypothesis of a dysregulation of the inflammatory balance toward a pro-inflammatory phenotype. Possible anti-inflammatory therapeutic approaches in glaucoma are also discussed.
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Affiliation(s)
- Christophe Baudouin
- Quinze-Vingts National Ophthalmology Hospital, INSERM-DGOS CIC 1423, IHU Foresight, Paris, France; Sorbonne Université, INSERM, CNRS, Institut de La Vision, Paris, France; Department of Ophthalmology, Ambroise Paré Hospital, APHP, Université de Versailles Saint-Quentin en Yvelines, Boulogne-Billancourt, France.
| | - Miriam Kolko
- Department of Drug Design and Pharmacology, University of Copenhagen, Copenhagen, Denmark; Department of Ophthalmology, Copenhagen University Hospital, Rigshospitalet-Glostrup, Glostrup, Denmark
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Wang B, Kasper M, Laffer B, Meyer zu Hörste G, Wasmuth S, Busch M, Jalilvand TV, Thanos S, Heiligenhaus A, Bauer D, Heinz C. Increased Hydrostatic Pressure Promotes Primary M1 Reaction and Secondary M2 Polarization in Macrophages. Front Immunol 2020; 11:573955. [PMID: 33154752 PMCID: PMC7591771 DOI: 10.3389/fimmu.2020.573955] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 08/26/2020] [Indexed: 12/30/2022] Open
Abstract
Patients with chronic anterior uveitis are at particularly high risk of developing secondary glaucoma when corticosteroids [e.g., dexamethasone (Dex)] are used or when inflammatory activity has regressed. Macrophage migration into the eye increases when secondary glaucoma develops and may play an important role in the development of secondary glaucoma. Our aim was to evaluate in vitro if increased hydrostatic pressure and corticosteroids could induce changes in macrophages phenotype. By using a pressure chamber cell culture system, we assessed the effect of increased hydrostatic pressure (HP), inflammation, and immunosuppression (Dex) on the M1/M2 phenotype of macrophages. Bone marrow-derived macrophages (BMDMs) were stimulated with medium, lipopolysaccharide (LPS, 100 ng/ml), Dex (200 ng/ml), or LPS + Dex and incubated with different HP (0, 20, or 60 mmHg) for 2 or 7 days. The numbers of CD86+/CD206- (M1 phenotype), CD86-/CD206+ (M2 phenotype), CD86+/CD206+ (intermediate phenotype), F4/80+/TNF-α+, and F4/80+/IL-10+ macrophages were determined by flow cytometry. TNF-α and IL-10 levels in cell culture supernatants were quantified by ELISA. TNF-α, IL-10, fibronectin, and collagen IV expression in BMDMs were detected by immunofluorescence microscopy. Higher HP polarizes macrophages primarily to an M1 phenotype (LPS, 60 vs. 0 mmHg, d2: p = 0.0034) with less extra cellular matrix (ECM) production and secondary to an M2 phenotype (medium, 60 vs. 0 mmHg, d7: p = 0.0089) (medium, 60 vs. 20 mmHg, d7: p = 0.0433) with enhanced ECM production. Dex induces an M2 phenotype (Dex, medium vs. Dex, d2: p < 0.0001; d7: p < 0.0001) with more ECM production. Higher HP further increased M2 polarization of Dex-treated macrophages (Dex, 60 vs. 0 mmHg, d2: p = 0.0417; d7: p = 0.0454). These changes in the M1/M2 phenotype by high HP or Dex treatment may play a role in the pathogenesis of secondary uveitic glaucoma- or glucocorticoid (GC)-induced glaucoma.
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Affiliation(s)
- Bo Wang
- Ophthalmology and Ophtha-Lab at St. Franziskus Hospital, Münster, Germany
| | - Maren Kasper
- Ophthalmology and Ophtha-Lab at St. Franziskus Hospital, Münster, Germany
| | - Björn Laffer
- Ophthalmology and Ophtha-Lab at St. Franziskus Hospital, Münster, Germany
| | - Gerd Meyer zu Hörste
- Institution of Neurology and Institution for Translational Neurology, Universitätsklinikum Münster, Münster, Germany
| | - Susanne Wasmuth
- Ophthalmology and Ophtha-Lab at St. Franziskus Hospital, Münster, Germany
| | - Martin Busch
- Ophthalmology and Ophtha-Lab at St. Franziskus Hospital, Münster, Germany
| | | | - Solon Thanos
- Institution of Experimental Ophthalmology, Westfälische Wilhelms-Universität, Münster, Germany
| | - Arnd Heiligenhaus
- Ophthalmology and Ophtha-Lab at St. Franziskus Hospital, Münster, Germany
- Ophthalmology, University of Duisburg-Essen, Essen, Germany
| | - Dirk Bauer
- Ophthalmology and Ophtha-Lab at St. Franziskus Hospital, Münster, Germany
| | - Carsten Heinz
- Ophthalmology and Ophtha-Lab at St. Franziskus Hospital, Münster, Germany
- Ophthalmology, University of Duisburg-Essen, Essen, Germany
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24
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Gazzard G, Konstantakopoulou E, Garway-Heath D, Garg A, Vickerstaff V, Hunter R, Ambler G, Bunce C, Wormald R, Nathwani N, Barton K, Rubin G, Morris S, Buszewicz M. Selective laser trabeculoplasty versus drops for newly diagnosed ocular hypertension and glaucoma: the LiGHT RCT. Health Technol Assess 2020; 23:1-102. [PMID: 31264958 DOI: 10.3310/hta23310] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Newly diagnosed open-angle glaucoma (OAG) and ocular hypertension (OHT) are habitually treated with intraocular pressure (IOP)-lowering eyedrops. Selective laser trabeculoplasty (SLT) is a safe alternative to drops and is rarely used as first-line treatment. OBJECTIVES To compare health-related quality of life (HRQoL) in newly diagnosed, treatment-naive patients with OAG or OHT, treated with two treatment pathways: topical IOP-lowering medication from the outset (Medicine-1st) or primary SLT followed by topical medications as required (Laser-1st). We also compared the clinical effectiveness and cost-effectiveness of the two pathways. DESIGN A 36-month pragmatic, unmasked, multicentre randomised controlled trial. SETTINGS Six collaborating specialist glaucoma clinics across the UK. PARTICIPANTS Newly diagnosed patients with OAG or OHT in one or both eyes who were aged ≥ 18 years and able to provide informed consent and read and understand English. Patients needed to qualify for treatment, be able to perform a reliable visual field (VF) test and have visual acuity of at least 6 out of 36 in the study eye. Patients with VF loss mean deviation worse than -12 dB in the better eye or -15 dB in the worse eye were excluded. Patients were also excluded if they had congenital, early childhood or secondary glaucoma or ocular comorbidities; if they had any previous ocular surgery except phacoemulsification, at least 1 year prior to recruitment or any active treatment for ophthalmic conditions; if they were pregnant; or if they were unable to use topical medical therapy or had contraindications to SLT. INTERVENTIONS SLT according to a predefined protocol compared with IOP-lowering eyedrops, as per national guidelines. MAIN OUTCOME MEASURES The primary outcome was HRQoL at 3 years [as measured using the EuroQol-5 Dimensions, five-level version (EQ-5D-5L) questionnaire]. Secondary outcomes were cost and cost-effectiveness, disease-specific HRQoL, clinical effectiveness and safety. RESULTS Of the 718 patients enrolled, 356 were randomised to Laser-1st (initial SLT followed by routine medical treatment) and 362 to Medicine-1st (routine medical treatment only). A total of 652 (91%) patients returned the primary outcome questionnaire at 36 months. The EQ-5D-5L score was not significantly different between the two arms [adjusted mean difference (Laser-1st - Medicine-1st) 0.01, 95% confidence interval (CI) -0.01 to 0.03; p = 0.23] at 36 months. Over 36 months, the proportion of visits at which IOP was within the target range was higher in the Laser-1st arm (93.0%, 95% CI 91.9% to 94.0%) than in the Medicine-1st arm (91.3%, 95% CI 89.9% to 92.5%), with IOP-lowering glaucoma surgery required in 0 and 11 patients, respectively. There was a 97% probability of Laser-1st being more cost-effective than Medicine-1st for the NHS, at a willingness to pay for a quality-adjusted life-year of £20,000, with a reduction in ophthalmology costs of £458 per patient (95% of bootstrap iterations between -£585 and -£345). LIMITATION An unmasked design, although a limitation, was essential to capture any treatment effects on patients' perception. The EQ-5D-5L questionnaire is a generic tool used in multiple settings and may not have been the most sensitive tool to investigate HRQoL. CONCLUSIONS Compared with medication, SLT provided a stable, drop-free IOP control to 74.2% of patients for at least 3 years, with a reduced need for surgery, lower cost and comparable HRQoL. Based on the evidence, SLT seems to be the most cost-effective first-line treatment option for OAG and OHT, also providing better clinical outcomes. FUTURE WORK Longitudinal research into the clinical efficacy of SLT as a first-line treatment will specify the long-term differences of disease progression, treatment intensity and ocular surgery rates between the two pathways. TRIAL REGISTRATION Current Controlled Trials ISRCTN32038223. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 23, No. 31. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Gus Gazzard
- National Institute for Health Research Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, London, UK.,Institute of Ophthalmology, University College London, London, UK
| | - Evgenia Konstantakopoulou
- National Institute for Health Research Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, London, UK.,Institute of Ophthalmology, University College London, London, UK
| | - David Garway-Heath
- National Institute for Health Research Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, London, UK.,Institute of Ophthalmology, University College London, London, UK
| | - Anurag Garg
- National Institute for Health Research Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, London, UK.,Institute of Ophthalmology, University College London, London, UK
| | - Victoria Vickerstaff
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK.,Research Department of Primary Care and Population Health, University College London, London, UK
| | - Rachael Hunter
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Gareth Ambler
- Department of Statistical Science, University College London, London, UK
| | - Catey Bunce
- National Institute for Health Research Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, London, UK.,School of Population Health and Environmental Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Richard Wormald
- National Institute for Health Research Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, London, UK.,Institute of Ophthalmology, University College London, London, UK.,London School of Hygiene & Tropical Medicine, London, UK
| | - Neil Nathwani
- National Institute for Health Research Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Keith Barton
- National Institute for Health Research Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, London, UK.,Institute of Ophthalmology, University College London, London, UK
| | - Gary Rubin
- Institute of Ophthalmology, University College London, London, UK
| | - Stephen Morris
- Department of Applied Health Research, Institute of Epidemiology and Health Care, University College London, London, UK
| | - Marta Buszewicz
- Research Department of Primary Care and Population Health, University College London, London, UK
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25
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Park Y, Cho KJ. Outcome of phacoemulsification in patients with open-angle glaucoma after selective laser trabeculoplasty. PLoS One 2020; 15:e0238394. [PMID: 32970691 PMCID: PMC7514032 DOI: 10.1371/journal.pone.0238394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 08/15/2020] [Indexed: 11/18/2022] Open
Abstract
Purpose To investigate the outcome of phacoemulsification in selective laser trabeculoplasty (SLT)-treated eyes. Methods This retrospective study included patients who had open angle glaucoma (OAG) with previous SLT who underwent phacoemulsification. We evaluated intraocular pressure (IOP), length of glaucoma control without treatment, and antiglaucoma medication or surgery. SLT-treated eyes that did not receive phacoemulsification were retrospectively chosen as a control. We investigated factors related to outcome of phacoemulsification by multivariate analysis. Results 42 eyes with previous SLT that underwent phacoemulsification and 40 controls were retrospectively evaluated. Phacoemulsification was performed 52 ± 15 months after SLT. After a mean follow-up of 74 ± 21 months, mean IOP was significantly decreased in the phaco group by 2.2 ± 2.7 mmHg (p < 0.001). In the SLT group, mean IOP was decreased by 0.8 ± 2.8 mmHg (p < 0.001). 9 eyes (16.7%) in the phaco group and 11 eyes (19.0%) of the SLT group needed topical treatment, and no eye needed glaucoma surgery in both groups. The factor related to success was higher baseline IOP (p = 0.002). Conclusion Prior SLT didn’t negatively influence phacoemulsification in patients with OAG. Phacoemulsification lowered IOP effectively and safely in OAG patients who were treated with SLT.
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Affiliation(s)
- Yuli Park
- Department of Ophthalmology, Dankook University Hospital, College of Medicine, Dankook University, Cheonan, Republic of Korea
| | - Kyong Jin Cho
- Department of Ophthalmology, Dankook University Hospital, College of Medicine, Dankook University, Cheonan, Republic of Korea
- Beckman Laser Institute Korea, Dankook University, Cheonan, Republic of Korea
- * E-mail:
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26
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Buffault J, Labbé A, Hamard P, Brignole-Baudouin F, Baudouin C. [The trabecular meshwork: Structure, function and clinical implications. A review of the littérature (French translation of the article)]. J Fr Ophtalmol 2020; 43:779-793. [PMID: 32807552 DOI: 10.1016/j.jfo.2020.04.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 04/17/2020] [Accepted: 04/22/2020] [Indexed: 11/26/2022]
Abstract
Glaucoma is a blinding optic neuropathy, the main risk factor for which is increased intraocular pressure (IOP). The trabecular meshwork, located within the iridocorneal angle, is the main pathway for drainage of aqueous humor (AH) out of the eye, and its dysfunction is responsible for the IOP elevation. The trabecular meshwork is a complex, fenestrated, three-dimensional structure composed of trabecular meshwork cells (TMC) interdigitated into a multilayered organization within the extracellular matrix (ECM). The purpose of this literature review is to provide an overview of current understanding of the trabecular meshwork and its pathophysiology in glaucoma. Thus, we will present the main anatomical and cellular bases for the regulation of aqueous humor outflow resistance, the pathophysiological mechanisms involved in trabecular dysfunction in the various types of glaucoma, as well as current and future therapeutic strategies targeting the trabecular meshwork.
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Affiliation(s)
- J Buffault
- Service d'ophtalmologie, centre hospitalier national d'ophtalmologie des Quinze-Vingts, IHU FOReSIGHT, 28, rue de Charenton, 75012 Paris, France.
| | - A Labbé
- Service d'ophtalmologie, centre hospitalier national d'ophtalmologie des Quinze-Vingts, IHU FOReSIGHT, 28, rue de Charenton, 75012 Paris, France; Service d'ophtalmologie, hôpital Ambroise-Paré, AP-HP, 9, avenue Charles-de-Gaulle, 92100 Boulogne-Billancourt, France; Inserm, CNRS, institut de la vision, Sorbonne université, 17, rue Moreau, 75012 Paris, France
| | - P Hamard
- Service d'ophtalmologie, centre hospitalier national d'ophtalmologie des Quinze-Vingts, IHU FOReSIGHT, 28, rue de Charenton, 75012 Paris, France
| | - F Brignole-Baudouin
- Inserm, CNRS, institut de la vision, Sorbonne université, 17, rue Moreau, 75012 Paris, France; Service de biologie médicale, centre hospitalier national d'ophtalmologie des Quinze-Vingts, IHU FOReSIGHT, 28, rue de Charenton, 75012 Paris, France
| | - C Baudouin
- Service d'ophtalmologie, centre hospitalier national d'ophtalmologie des Quinze-Vingts, IHU FOReSIGHT, 28, rue de Charenton, 75012 Paris, France; Service d'ophtalmologie, hôpital Ambroise-Paré, AP-HP, 9, avenue Charles-de-Gaulle, 92100 Boulogne-Billancourt, France; Inserm, CNRS, institut de la vision, Sorbonne université, 17, rue Moreau, 75012 Paris, France
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27
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The trabecular meshwork: Structure, function and clinical implications. A review of the literature. J Fr Ophtalmol 2020; 43:e217-e230. [PMID: 32561029 DOI: 10.1016/j.jfo.2020.05.002] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Revised: 04/25/2020] [Accepted: 05/27/2020] [Indexed: 02/06/2023]
Abstract
Glaucoma is a blinding optic neuropathy, the main risk factor for which is increased intraocular pressure (IOP). The trabecular meshwork, located within the iridocorneal angle, is the main pathway for drainage of aqueous humor (AH) out of the eye, and its dysfunction is responsible for the IOP elevation. The trabecular meshwork is a complex, fenestrated, three-dimensional structure composed of trabecular meshwork cells (TMC) interdigitated into a multilayered organization within the extracellular matrix (ECM). The purpose of this literature review is to provide an overview of current understanding of the trabecular meshwork and its pathophysiology in glaucoma. Thus, we will present the main anatomical and cellular bases for the regulation of aqueous humor outflow resistance, the pathophysiological mechanisms involved in trabecular dysfunction in the various types of glaucoma, as well as current and future therapeutic strategies targeting the trabecular meshwork.
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28
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Sacks ZS, Dobkin-Bekman M, Geffen N, Goldenfeld M, Belkin M. Non-contact direct selective laser trabeculoplasty: light propagation analysis. BIOMEDICAL OPTICS EXPRESS 2020; 11:2889-2904. [PMID: 32637231 PMCID: PMC7316017 DOI: 10.1364/boe.390849] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 04/29/2020] [Accepted: 04/30/2020] [Indexed: 06/11/2023]
Abstract
Selective laser trabeculoplasty (SLT), used to treat glaucoma and ocular hypertension, requires the use of a gonioscope placed on the cornea to visualize and irradiate the trabecular meshwork (TM). Alternatively, non-contact direct SLT (DSLT) irradiates the TM through the overlying tissues. Here we analyze this innovative procedure using analytical modeling and Monte Carlo simulations to quantify the laser energy reaching the TM through the overlying tissues. Compared with energy launched from the laser, DSLT energy transmission to the TM is 2.8 times less than SLT, which verifies the efficacy of non-contact DSLT given the lowest reported effective SLT energies.
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Affiliation(s)
- Zachary S. Sacks
- BELKIN Laser, Ltd., 13 Gan Raveh, POB 13254, Yavne 8122214, Israel
| | | | - Noa Geffen
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- Department of Ophthalmology, Rabin Medical Center, Petah Tikva 49100, Israel
| | | | - Michael Belkin
- BELKIN Laser, Ltd., 13 Gan Raveh, POB 13254, Yavne 8122214, Israel
- Goldschleger Eye Research Institute, Tel Aviv University, Tel Hashomer 52621, Israel
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29
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van Zyl T, Yan W, McAdams A, Peng YR, Shekhar K, Regev A, Juric D, Sanes JR. Cell atlas of aqueous humor outflow pathways in eyes of humans and four model species provides insight into glaucoma pathogenesis. Proc Natl Acad Sci U S A 2020; 117:10339-10349. [PMID: 32341164 PMCID: PMC7229661 DOI: 10.1073/pnas.2001250117] [Citation(s) in RCA: 100] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Increased intraocular pressure (IOP) represents a major risk factor for glaucoma, a prevalent eye disease characterized by death of retinal ganglion cells; lowering IOP is the only proven treatment strategy to delay disease progression. The main determinant of IOP is the equilibrium between production and drainage of aqueous humor, with compromised drainage generally viewed as the primary contributor to dangerous IOP elevations. Drainage occurs through two pathways in the anterior segment of the eye called conventional and uveoscleral. To gain insights into the cell types that comprise these pathways, we used high-throughput single-cell RNA sequencing (scRNAseq). From ∼24,000 single-cell transcriptomes, we identified 19 cell types with molecular markers for each and used histological methods to localize each type. We then performed similar analyses on four organisms used for experimental studies of IOP dynamics and glaucoma: cynomolgus macaque (Macaca fascicularis), rhesus macaque (Macaca mulatta), pig (Sus scrofa), and mouse (Mus musculus). Many human cell types had counterparts in these models, but differences in cell types and gene expression were evident. Finally, we identified the cell types that express genes implicated in glaucoma in all five species. Together, our results provide foundations for investigating the pathogenesis of glaucoma and for using model systems to assess mechanisms and potential interventions.
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Affiliation(s)
- Tavé van Zyl
- Department of Ophthalmology, Harvard Medical School and Massachusetts Eye and Ear, Boston, MA 02114;
- Center for Brain Science, Harvard University, Cambridge, MA 02138
- Department of Molecular and Cellular Biology, Harvard University, Cambridge, MA 02138
| | - Wenjun Yan
- Center for Brain Science, Harvard University, Cambridge, MA 02138
- Department of Molecular and Cellular Biology, Harvard University, Cambridge, MA 02138
| | - Alexi McAdams
- Department of Ophthalmology, Harvard Medical School and Massachusetts Eye and Ear, Boston, MA 02114
- Center for Brain Science, Harvard University, Cambridge, MA 02138
- Department of Molecular and Cellular Biology, Harvard University, Cambridge, MA 02138
| | - Yi-Rong Peng
- Center for Brain Science, Harvard University, Cambridge, MA 02138
- Department of Molecular and Cellular Biology, Harvard University, Cambridge, MA 02138
| | - Karthik Shekhar
- Howard Hughes Medical Institute, Massachusetts Institute of Technology, Cambridge, MA 02142
- Koch Institute of Integrative Cancer Research, Department of Biology, Massachusetts Institute of Technology, Cambridge, MA 02142
| | - Aviv Regev
- Howard Hughes Medical Institute, Massachusetts Institute of Technology, Cambridge, MA 02142
- Koch Institute of Integrative Cancer Research, Department of Biology, Massachusetts Institute of Technology, Cambridge, MA 02142
- Klarman Cell Observatory, Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, MA 02142
| | - Dejan Juric
- Department of Medicine, Harvard Medical School and Massachusetts General Hospital Cancer Center, Boston, MA 02114
| | - Joshua R Sanes
- Center for Brain Science, Harvard University, Cambridge, MA 02138;
- Department of Molecular and Cellular Biology, Harvard University, Cambridge, MA 02138
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30
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Xiao J, Zhao C, Liang A, Zhang M, Cheng G. Efficacy and Safety of High-Energy Selective Laser Trabeculoplasty for Steroid-Induced Glaucoma in Patients with Quiescent Uveitis. Ocul Immunol Inflamm 2020; 29:766-770. [PMID: 31902258 DOI: 10.1080/09273948.2019.1687730] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Junyan Xiao
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Chan Zhao
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Anyi Liang
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Meifen Zhang
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Gangwei Cheng
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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31
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Garg A, Gazzard G. Treatment choices for newly diagnosed primary open angle and ocular hypertension patients. Eye (Lond) 2020; 34:60-71. [PMID: 31685971 PMCID: PMC7002706 DOI: 10.1038/s41433-019-0633-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 09/04/2019] [Accepted: 09/11/2019] [Indexed: 12/17/2022] Open
Abstract
Despite advances in our knowledge of the aetiology and pathophysiology of glaucoma, the sole proven, effective intervention for treating primary open-angle glaucoma (POAG) and ocular hypertension (OHT) remains lowering of intraocular pressure (IOP) to prevent further progression and visual loss. The purpose of this review is to evaluate the treatment choices available to newly diagnosed POAG and OHT patients. We review the existing literature on treatments currently available to newly diagnosed POAG and OHT patients and discuss their role in the treatment paradigm of POAG and OHT. We consider different factors that may be important when offering a choice of treatment to newly diagnosed POAG and OHT patients as well as describing new glaucoma treatments in development and future directions for treatment.
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Affiliation(s)
- Anurag Garg
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
| | - Gus Gazzard
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK.
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32
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Özer MA, Oğurel T, Özen S, Küçüksümer Y. Evaluation of the effects of selective laser trabeculoplasty on anterior segment parameters by anterior segment optical coherence tomography. Lasers Med Sci 2019; 35:1271-1275. [DOI: 10.1007/s10103-019-02904-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Accepted: 10/18/2019] [Indexed: 12/01/2022]
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33
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Moazzeni H, Mirrahimi M, Moghadam A, Banaei-Esfahani A, Yazdani S, Elahi E. Identification of genes involved in glaucoma pathogenesis using combined network analysis and empirical studies. Hum Mol Genet 2019; 28:3637-3663. [PMID: 31518395 DOI: 10.1093/hmg/ddz222] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 08/30/2019] [Accepted: 09/04/2019] [Indexed: 12/25/2022] Open
Abstract
Glaucoma is a leading cause of blindness. We aimed in this study to identify genes that may make subtle and cumulative contributions to glaucoma pathogenesis. To this end, we identified molecular interactions and pathways that include transcription factors (TFs) FOXC1, PITX2, PAX6 and NFKB1 and various microRNAs including miR-204 known to have relevance to trabecular meshwork (TM) functions and/or glaucoma. TM tissue is involved in glaucoma pathogenesis. In-house microarray transcriptome results and data sources were used to identify target genes of the regulatory molecules. Bioinformatics analyses were done to filter TM and glaucoma relevant genes. These were submitted to network-creating softwares to define interactions, pathways and a network that would include the genes. The network was stringently scrutinized and minimized, then expanded by addition of microarray data and data on TF and microRNA-binding sites. Selected features of the network were confirmed by empirical studies such as dual luciferase assays, real-time PCR and western blot experiments and apoptosis assays. MYOC, WDR36, LTPBP2, RHOA, CYP1B1, OPA1, SPARC, MEIS2, PLEKHG5, RGS5, BBS5, ALDH1A1, NOMO2, CXCL6, FMNL2, ADAMTS5, CLOCK and DKK1 were among the genes included in the final network. Pathways identified included those that affect ECM properties, IOP, ciliary body functions, retinal ganglion cell viability, apoptosis, focal adhesion and oxidative stress response. The identification of many genes potentially involved in glaucoma pathology is consistent with its being a complex disease. The inclusion of several known glaucoma-related genes validates the approach used.
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Affiliation(s)
- Hamidreza Moazzeni
- School of Biology, College of Science, University of Tehran, Tehran, Iran
- Department of Medical Genetics, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Mehraban Mirrahimi
- School of Biology, College of Science, University of Tehran, Tehran, Iran
| | - Abolfazl Moghadam
- School of Biology, College of Science, University of Tehran, Tehran, Iran
| | - Amir Banaei-Esfahani
- Department of Biotechnology, College of Science, University of Tehran, Tehran, Iran
| | - Shahin Yazdani
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Elahe Elahi
- School of Biology, College of Science, University of Tehran, Tehran, Iran
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34
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Xu L, Yu RJ, Ding XM, Li M, Wu Y, Zhu L, Chen D, Peng C, Zeng CJ, Guo WY. Efficacy of low-energy selective laser trabeculoplasty on the treatment of primary open angle glaucoma. Int J Ophthalmol 2019; 12:1432-1437. [PMID: 31544039 DOI: 10.18240/ijo.2019.09.10] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 04/08/2019] [Indexed: 12/20/2022] Open
Abstract
AIM To investigate the efficacy of low-energy selective laser trabeculoplasty (SLT) on the treatment of primary open angle glaucoma (POAG) patients. METHODS Outpatients with POAG who underwent 360-degree SLT using an initial energy of 0.3 mJ (total energy of 30-40 mJ) were reviewed retrospectively from September 2011 to January 2018. RESULTS Eight-six eyes of 44 POAG patients underwent 360-degree SLT using initial energy of 0.3 mJ and were followed up regularly. The total energy used was 32.5±2.5 mJ (23-40 mJ, 105±6 spots). The average pretreatment intraocular pressure (IOP) was 19.8±3.9 mm Hg. At 1, 3, 6mo, 1, and 2y, the post-SLT IOPs (mm Hg) were 16.9±3.3, 16.5±3.3, 17.1±3.4, 16.6±3.5, 16.5±2.8, which were significantly lower than that before treatment (P<0.001). The patients in the SLT success group were found to be younger than those in the SLT failure group. After SLT, 59 eyes that maintained pretreatment medications were defined as the drug retention group. The pre-SLT IOP was 20.1±3.7 mm Hg. At 1, 3, 6mo, 1, and 2y, the post-SLT IOPs (mm Hg) were 17.3±3.6, 16.6±3.5, 17.2±3.6, 16.9±3.8 and 16.5±2.9, respectively. Twenty-seven eyes that required reduced drugs were defined as the drug reduction group. The pre-SLT IOP was 19.2±4.4 mm Hg. At 1, 3, 6mo, 1, and 2y, the post-SLT IOPs (mm Hg) were 16.1±2.6, 16.5±3.1, 16.8±2.9, 16.0±2.6 and 16.3±2.4, respectively. Compared with the pretreatment IOPs, the post-SLT IOPs were significantly lower in drug retention group and drug reduction group. The patients in the drug reduction group were found to be younger than those in the drug retention group. CONCLUSION Low-energy SLT is safe and effective for POAG patients during a 2-year follow-up. Younger POAG patients may obtain better results after low-energy SLT treatment.
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Affiliation(s)
- Li Xu
- Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China.,Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai 200011, China
| | - Ru-Jing Yu
- Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China.,Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai 200011, China
| | - Xu-Ming Ding
- Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China.,Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai 200011, China
| | - Mao Li
- Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China.,Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai 200011, China
| | - Yue Wu
- Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China.,Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai 200011, China
| | - Li Zhu
- Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China.,Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai 200011, China
| | - Di Chen
- Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China.,Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai 200011, China
| | - Cheng Peng
- Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China.,Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai 200011, China
| | - Chang-Juan Zeng
- Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China.,Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai 200011, China
| | - Wen-Yi Guo
- Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China.,Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai 200011, China
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Park Y, Kim YB, Cho KJ. Effect of Preoperative Factors and Gonioscopy on Intraocular Pressure Reduction after Phacoemulsification in Glaucoma. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2019. [DOI: 10.3341/jkos.2019.60.5.463] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Yuli Park
- Department of Ophthalmology, Dankook University College of Medicine, Cheonan, Korea
| | - Young Bin Kim
- Department of Ophthalmology, Dankook University College of Medicine, Cheonan, Korea
| | - Kyong Jin Cho
- Department of Ophthalmology, Dankook University College of Medicine, Cheonan, Korea
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Margeta MA, Lad EM, Proia AD. CD163+ macrophages infiltrate axon bundles of postmortem optic nerves with glaucoma. Graefes Arch Clin Exp Ophthalmol 2018; 256:2449-2456. [PMID: 30073622 DOI: 10.1007/s00417-018-4081-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Revised: 06/12/2018] [Accepted: 07/26/2018] [Indexed: 12/20/2022] Open
Abstract
PURPOSE Prior research in animal models has shown that macrophages and microglia play an important role in pathogenesis of glaucoma, but the phenotype and distribution of macrophages in human glaucomatous tissue have not been sufficiently characterized. METHODS We analyzed H&E, CD68-, and CD163-immunostained slides from 25 formaldehyde-fixed, paraffin-embedded autopsy eyes: 12 control eyes and 13 eyes with glaucoma. The diagnosis of glaucoma was made based on a history of glaucoma as reported in the medical record and histological changes characteristic of glaucoma. Glaucoma cases and controls were matched in terms of age, sex, and race. RESULTS Qualitative analysis of the conventional outflow pathway and the optic nerve revealed that all eyes contained CD163+ cells but a negligible number of CD68+ cells. CD163+ macrophages infiltrated the trabecular meshwork and surrounded Schlemm's canal of normal eyes and eyes with glaucoma, but the pattern was variable and qualitatively similar between groups. In optic nerves of control eyes, CD163+ macrophages were present at low levels and restricted to septa between axon bundles. In glaucomatous optic nerves, the number of CD163+ cells was increased both qualitatively and quantitatively (glaucoma 5.1 ± 0.6 CD163+ cells/mm2, control 2.5 ± 0.3 CD163+ cells/mm2, p < 0.001), with CD163+ cells infiltrating axon bundles in cases of both mild and severe diseases. CONCLUSIONS The increase in CD163+ cell number in eyes with mild and severe glaucoma is the first demonstration of macrophage infiltration in glaucomatous human optic nerves. This finding supports a role for macrophages in glaucoma pathogenesis and progression.
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Affiliation(s)
- Milica A Margeta
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, 243 Charles Street, Boston, MA, 02114, USA.
| | - Eleonora M Lad
- Department of Ophthalmology, Duke University Medical Center, Durham, NC, USA
| | - Alan D Proia
- Department of Ophthalmology, Duke University Medical Center, Durham, NC, USA.,Department of Pathology, Duke University Medical Center, Durham, NC, USA
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Örnek N, Örnek K. The use of selective laser trabeculoplasty to treat glaucoma. EXPERT REVIEW OF OPHTHALMOLOGY 2018. [DOI: 10.1080/17469899.2018.1503533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Nurgül Örnek
- Department of Ophthalmology, School of Medicine, Kırıkkale University, Kırıkkale, Turkey
| | - Kemal Örnek
- Department of Ophthalmology, Kudret Eye Hospital, Ankara, Turkey
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Selective laser trabeculoplasty: past, present, and future. Eye (Lond) 2018; 32:863-876. [PMID: 29303146 DOI: 10.1038/eye.2017.273] [Citation(s) in RCA: 75] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Accepted: 11/02/2017] [Indexed: 11/09/2022] Open
Abstract
Over the past two decades, selective laser trabeculoplasty (SLT) has increasingly become an established laser treatment used to lower intraocular pressure in open-angle glaucoma and ocular hypertensive patients. In this review we trace the origins of SLT from previous argon laser trabeculoplasty and review the current role it has in clinical practice. We outline future directions of SLT research and introduce emerging technologies that are further developing this intervention in the treatment paradigm of glaucoma.
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Park Y, Moon JI, Cho KJ. The Effect of Intraoperative Factors on Intraocular Pressure Reduction after Phacoemulsification in Open-angle Glaucoma. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2018. [DOI: 10.3341/jkos.2018.59.10.930] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Yuli Park
- Department of Ophthalmology, Dankook University Hospital, Dankook University College of Medicine, Cheonan, Korea
| | - Jung Il Moon
- Department of Ophthalmology, Yeouido St.Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Kyong Jin Cho
- Department of Ophthalmology, Dankook University Hospital, Dankook University College of Medicine, Cheonan, Korea
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Randomized Controlled Comparison of Titanium-Sapphire Versus Standard Q-Switched Nd: YAG Laser Trabeculoplasty. J Glaucoma 2017; 25:e663-7. [PMID: 26325273 DOI: 10.1097/ijg.0000000000000317] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To evaluate the clinical effects of laser trabeculoplasty using a novel 790 nm wavelength titanium-sapphire laser (TLT) compared with a 532 nm Q-switched Nd:YAG laser used in standard selective laser trabeculoplasty (SLT). METHODS Single institution prospective clinical trial of open-angle glaucoma patients randomized to TLT or SLT at the Yale Eye Center from 2011 to 2012. Patients with previous glaucoma surgery or trabeculoplasty were excluded. Trabeculoplasty was performed by a single surgeon unmasked to treatment group. All patients received 360 degrees of treatment. The main outcome measure was intraocular pressure (IOP) at 2 years. RESULTS Thirty-seven patients were enrolled. The mean baseline IOPs were 19.7 in TLT (n=18) and 20.4 mm Hg in SLT (n=19, P=0.69).At 2 years, the mean IOP was 12.9 mm Hg (35% decrease, P<0.001) in the TLT group and 15.4 mm Hg (25% decrease, P=0.006) in the SLT group. The 2 groups did not differ in glaucoma medication use. Success, defined as IOP<21 mm Hg with >20% reduction from baseline without the need for secondary glaucoma procedures, occurred in 44% of TLT patients and 61% of SLT patients at 1 year and in 22% of TLT patients and 46% of SLT patients at 2 years (P=0.11). No patients experienced significant pain, anterior chamber reaction, corneal edema, or loss of vision. CONCLUSIONS TLT may be a safe and effective alternative to SLT to lower IOP in patients with open-angle glaucoma.
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Abstract
PURPOSE OF THE STUDY The purpose of the study was to investigate results of selective laser trabeculoplasty (SLT) performed directly on the sclera without a gonioscopy lens. DESIGN Interventional case series, prospective, randomized, masked, controlled clinical trial. METHODS Setting: Meir Medical Center, Kfar-Saba, Israel. STUDY POPULATION Adults with uncontrolled primary open angle or pseudoexfoliation glaucoma randomized into 2 groups. INTERVENTION The controls underwent conventional SLT with 100 spots delivered using a gonioscopy lens for 360 degrees of the trabecular meshwork. The study group underwent irradiation using the same parameters with the laser applications administered on the perilimbal sclera. Study visits: 1 hour, 1, 7, 30, 60, 180, and 365 days postprocedure. MAIN OUTCOME MEASURES Intraocular pressure (IOP) and side effects. RESULTS Thirty adults were randomized into 2 groups. The mean (±SD) pretreatment IOP was 20.21±3.19 mm Hg for the study group (n=14) and 21.14±2.98 mm Hg for the controls (n=14; P =0.43), dropping to 15.50±3.77 and 15.00±4.08 mm Hg (P =0.74) after 6 months and to 16.00±3.31 and 14.00±2.45 mm Hg (P =0.22) after 12 months. The average IOP reduction after 6 and 12 months was 23.4% and 20.83% for the study group and 27.1% and 33.77% for the controls (P=0.528). Success (a decrease of ≥15% at 6 months with no additional medications, laser, or glaucoma surgery) was achieved in 12 (85.7%) study patients and 9 (69.2%) controls (P=0.385). Complications were mild and transient (n=30), although significantly higher in the controls (n=15; P <0.0001). CONCLUSIONS SLT applied directly to the perilimbal sclera may be as efficacious as the conventional procedure for 1 year.
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Klingeborn M, Dismuke WM, Bowes Rickman C, Stamer WD. Roles of exosomes in the normal and diseased eye. Prog Retin Eye Res 2017; 59:158-177. [PMID: 28465248 PMCID: PMC5537591 DOI: 10.1016/j.preteyeres.2017.04.004] [Citation(s) in RCA: 108] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Revised: 04/28/2017] [Accepted: 04/28/2017] [Indexed: 12/21/2022]
Abstract
Exosomes are nanometer-sized vesicles that are released by cells in a controlled fashion and mediate a plethora of extra- and intercellular activities. Some key functions of exosomes include cell-cell communication, immune modulation, extracellular matrix turnover, stem cell division/differentiation, neovascularization and cellular waste removal. While much is known about their role in cancer, exosome function in the many specialized tissues of the eye is just beginning to undergo rigorous study. Here we review current knowledge of exosome function in the visual system in the context of larger bodies of data from other fields, in both health and disease. Additionally, we discuss recent advances in the exosome field including use of exosomes as a therapeutic vehicle, exosomes as a source of biomarkers for disease, plus current standards for isolation and validation of exosome populations. Finally, we use this foundational information about exosomes in the eye as a platform to identify areas of opportunity for future research studies.
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Affiliation(s)
- Mikael Klingeborn
- Department of Ophthalmology, Duke Eye Center, Duke University, Durham, NC 27710, USA
| | - W Michael Dismuke
- Department of Ophthalmology, Duke Eye Center, Duke University, Durham, NC 27710, USA
| | - Catherine Bowes Rickman
- Department of Ophthalmology, Duke Eye Center, Duke University, Durham, NC 27710, USA; Department of Cell Biology, Duke University, Durham, NC 27710, USA
| | - W Daniel Stamer
- Department of Ophthalmology, Duke Eye Center, Duke University, Durham, NC 27710, USA; Department of Biomedical Engineering, Duke University, Durham, NC 27710, USA.
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Microarchitecture of Schlemm Canal Before and After Selective Laser Trabeculoplasty in Enhanced Depth Imaging Optical Coherence Tomography. J Glaucoma 2017; 26:361-366. [DOI: 10.1097/ijg.0000000000000624] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Moazzeni H, Akbari MT, Yazdani S, Elahi E. Expression of CXCL6 and BBS5 that may be glaucoma relevant genes is regulated by PITX2. Gene 2016; 593:76-83. [PMID: 27520585 DOI: 10.1016/j.gene.2016.08.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Revised: 07/31/2016] [Accepted: 08/08/2016] [Indexed: 12/26/2022]
Abstract
The transcription factor PITX2 is implicated in glaucoma pathology. In an earlier study we had used microarray analysis to identify genes in the trabecular meshwork (TM) that are affected by knock down of PITX2. Here, those studies were pursued to identify genes that are direct targets of PITX2 and that may be relevant to glaucoma. Initially, bioinformatics tools were used to select among the genes that had been affected by PITX2 knock down those that have PITX2 binding sites and that may be involved in glaucoma related functions. Subsequently, the effect of PITX2 was tested using the dual luciferase assay in four cell cultures including two primary TM cultures co-transfected with vectors containing promoter fragments of six candidate genes upstream of a luciferase gene and a vector that expressed PITX2. Finally, the effect of PITX2 on endogenous expression of two genes was assessed by over expression and knock down of PITX2 in TM cells. Thirty four genes were found to contain PITX2 binding sites in their putative promoter regions, and 16 were found to be associated with TM-specific and/or glaucoma associated functions. Results of dual luciferase assays confirmed that two of six genes tested were directly targeted by PITX2. The two genes were CXCL6 (chemokine (C-X-C motif) ligand 6) and BBS5 (Bardet-Biedl syndrome 5). Over expression and knock down of PITX2 showed that this transcription factor affects endogenous expression of these two genes in TM cells. CXCL6 encodes a pro-inflammatory cytokine, and many studies have suggested that cytokines and other immune system functions are involved in glaucoma pathogenesis. BBS5 is a member of the BBS family of genes that affect ciliary functions, and ciliary bodies in the anterior chamber of the eye produce the aqueous fluid that affects intraocular pressure. Immune related functions and intraocular pressure are both important components of glaucoma pathology. The role of PITX2 in glaucoma may be mediated partly by regulating the expression of CXCL6 and BBS5 and thus affecting immune functions and intraocular pressure.
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Affiliation(s)
- Hamidreza Moazzeni
- Department of Medical Genetics, Faculty of Medical Sciences, Tarbiat Modares University, P.O. Box. 14115-331, Tehran, Iran
| | - Mohammad Taghi Akbari
- Department of Medical Genetics, Faculty of Medical Sciences, Tarbiat Modares University, P.O. Box. 14115-331, Tehran, Iran.
| | - Shahin Yazdani
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Elahe Elahi
- School of Biology, College of Science, University of Tehran, Tehran, Iran; Department of Biotechnology, College of Science, University of Tehran, Tehran, Iran.
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Toguri JT, Caldwell M, Kelly MEM. Turning Down the Thermostat: Modulating the Endocannabinoid System in Ocular Inflammation and Pain. Front Pharmacol 2016; 7:304. [PMID: 27695415 PMCID: PMC5024674 DOI: 10.3389/fphar.2016.00304] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Accepted: 08/26/2016] [Indexed: 11/13/2022] Open
Abstract
The endocannabinoid system (ECS) has emerged as an important regulator of both physiological and pathological processes. Notably, this endogenous system plays a key role in the modulation of pain and inflammation in a number of tissues. The components of the ECS, including endocannabinoids, their cognate enzymes and cannabinoid receptors, are localized in the eye, and evidence indicates that ECS modulation plays a role in ocular disease states. Of these diseases, ocular inflammation presents a significant medical problem, given that current clinical treatments can be ineffective or are associated with intolerable side-effects. Furthermore, a prominent comorbidity of ocular inflammation is pain, including neuropathic pain, for which therapeutic options remain limited. Recent evidence supports the use of drugs targeting the ECS for the treatment of ocular inflammation and pain in animal models; however, the potential for therapeutic use of cannabinoid drugs in the eye has not been thoroughly investigated at this time. This review will highlight evidence from experimental studies identifying components of the ocular ECS and discuss the functional role of the ECS during different ocular inflammatory disease states, including uveitis and corneal keratitis. Candidate ECS targeted therapies will be discussed, drawing on experimental results obtained from both ocular and non-ocular tissue(s), together with their potential application for the treatment of ocular inflammation and pain.
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Affiliation(s)
- James T. Toguri
- Department of Pharmacology, Dalhousie University, HalifaxNS, Canada
| | - Meggie Caldwell
- Department of Pharmacology, Dalhousie University, HalifaxNS, Canada
| | - Melanie E. M. Kelly
- Department of Pharmacology, Dalhousie University, HalifaxNS, Canada
- Department of Ophthalmology and Visual Sciences, Dalhousie University, HalifaxNS, Canada
- Anesthesia, Pain Management & Perioperative Medicine, Dalhousie University, HalifaxNS, Canada
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Intraocular Pressure-Lowering Potential of Subthreshold Selective Laser Trabeculoplasty in Patients with Primary Open-Angle Glaucoma. J Ophthalmol 2016; 2016:2153723. [PMID: 27529032 PMCID: PMC4978834 DOI: 10.1155/2016/2153723] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2016] [Revised: 05/25/2016] [Accepted: 06/26/2016] [Indexed: 11/17/2022] Open
Abstract
Purpose. To compare the efficacy of subthreshold and conventional selective laser trabeculoplasty (SLT) in lowering intraocular pressure (IOP) in the patients with primary open-angle glaucoma (POAG). Methods. Fifty-two eyes from fifty-two POAG patients were randomized into two groups, one group treated with subthreshold SLT using two-thirds of the conventional energy and the other one treated with the conventional energy. IOP was measured with the Goldmann tonometer and the anterior chamber inflammation was determined using laser flare meter. Results. The initial energy dosage used in subthreshold SLT group was significantly lower than the amount of the energy used in conventional SLT group (0.4 ± 0.1 mJ versus 0.6 ± 0.1 mJ, P = 0.030). The total energy dosage was also significantly lower in subthreshold SLT group compared to the other group (37.6 ± 3.3 mJ versus 51.8 ± 5.7 mJ, P = 0.036). However, the level of inflammation in aqueous humor, amount of reduction in IOP, and the success rate in controlling IOP was the same in both groups. Conclusion. The efficacy of subthreshold SLT group in reducing IOP in POAG patients is comparable to the efficacy of conventional SLT group.
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Alvarado JA, Chau P, Wu J, Juster R, Shifera AS, Geske M. Profiling of Cytokines Secreted by Conventional Aqueous Outflow Pathway Endothelial Cells Activated In Vitro and Ex Vivo With Laser Irradiation. Invest Ophthalmol Vis Sci 2016; 56:7100-8. [PMID: 26529044 DOI: 10.1167/iovs.15-17660] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
PURPOSE To profile which cytokine genes are differentially expressed (DE) as up- or downregulated by cultured human trabecular meshwork (TMEs) and Schlemm's canal endothelial cells (SCEs) after three experimental treatments consisting of selective laser trabeculoplasty (SLT) irradiation, exposure to media conditioned either by SLT-irradiated TMEs (TME-cm) or by SCEs (SCE-cm). Also, to profile which cytokines are upregulated ex vivo in SLT-irradiated human conventional aqueous outflow pathway (CAOP) tissues. METHODS After each treatment, Affymetrix microarray assays were used to detect upregulated and downregulated genes for cytokines and their receptors in TMEs and SCEs. ELISA and protein antibody arrays were used to detect upregulated cytokines secreted in SLT-irradiated CAOP tissues ex vivo. RESULTS The SLT irradiation upregulated numerous cytokine genes in TMEs, but only a few in SCEs. Exposure to TME- and SCE-cm induced SCEs to upregulate many more cytokine genes than TMEs. Selective laser trabeculoplasty irradiation and exposure to TME-cm downregulated several cytokine genes in TMEs but none in SCEs. Selective laser trabeculoplasty irradiation induced one upregulated and three downregulated cytokine-receptor genes in TMEs but none in SCEs. Exposure to TME-cm induced upregulation of one and downregulation of another receptor gene in TMEs, whereas two unique cytokine-receptor genes were upregulated in SCEs. Cytokine protein expression analysis showed that at least eight cytokines were upregulated in SLT-irradiated human CAOP tissues in situ/ex vivo. CONCLUSIONS This study has helped us identify a cytokine signaling pathway and to consider newly identified mechanisms regulating aqueous outflow that may lay the foundation for the future development of cytokine-based glaucoma therapies.
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Affiliation(s)
- Jorge A Alvarado
- Beckman Vision Center Department of Ophthalmology, University of California San Francisco, San Francisco, California, United States
| | - Phuonglan Chau
- Beckman Vision Center Department of Ophthalmology, University of California San Francisco, San Francisco, California, United States
| | - Jianfeng Wu
- Beckman Vision Center Department of Ophthalmology, University of California San Francisco, San Francisco, California, United States
| | - Richard Juster
- Beckman Vision Center Department of Ophthalmology, University of California San Francisco, San Francisco, California, United States
| | - Amde Selassie Shifera
- Casey Eye Institute, Oregon Health and Science University, Portland, Oregon, United States
| | - Michael Geske
- Beckman Vision Center Department of Ophthalmology, University of California San Francisco, San Francisco, California, United States
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Saccà SC, Gandolfi S, Bagnis A, Manni G, Damonte G, Traverso CE, Izzotti A. The Outflow Pathway: A Tissue With Morphological and Functional Unity. J Cell Physiol 2016; 231:1876-93. [PMID: 26754581 DOI: 10.1002/jcp.25305] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Accepted: 01/06/2016] [Indexed: 12/17/2022]
Abstract
The trabecular meshwork (TM) plays an important role in high-tension glaucomas. Indeed, the TM is a true organ, through which the aqueous humor flows from the anterior chamber to Schlemm's canal (SC). Until recently, the TM, which is constituted by endothelial-like cells, was described as a kind of passive filter. In reality, it is much more. The cells delineating the structures of the collagen framework of the TM are endowed with a cytoskeleton, and are thus able to change their shape. These cells also have the ability to secrete the extracellular matrix, which expresses proteins and cytokines, and are capable of phagocytosis and autophagy. The cytoskeleton is attached to the nuclear membrane and can, in millionths of a second, send signals to the nucleus in order to alter the expression of genes in an attempt to adapt to biomechanical insult. Oxidative stress, as happens in aging, has a deleterious effect on the TM, leading eventually to cell decay, tissue malfunction, subclinical inflammation, changes in the extracellular matrix and cytoskeleton, altered motility, reduced outflow facility, and (ultimately) increased IOP. TM failure is the most relevant factor in the cascade of events triggering apoptosis in the inner retinal layers, including ganglion cells. J. Cell. Physiol. 231: 1876-1893, 2016. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Sergio Claudio Saccà
- Department of Neuroscience and Sense Organs, Ophthalmology Unit, IRCCS San Martino University Hospital, San Martino Hospital, Genoa, Italy
| | - Stefano Gandolfi
- Department of Biological, Biotechnological and Translational Sciences, Ophthalmology Unit, University of Parma, Parma, Italy
| | - Alessandro Bagnis
- Department of Neuroscience and Sense Organs, Eye Clinic, University of Genoa, Genoa, Italy
| | - Gianluca Manni
- Department of Clinical Science and Translational Medicine, University Tor Vergata, Rome, Italy
| | - Gianluca Damonte
- Department of Experimental Medicine, Section of Biochemistry and Center of Excellence for Biomedical Research, University of Genoa, Genoa, Italy
| | - Carlo Enrico Traverso
- Department of Neuroscience and Sense Organs, Eye Clinic, University of Genoa, Genoa, Italy
| | - Alberto Izzotti
- Department of Health Sciences, Mutagenesis Unit, IRCCS San Martino University Hospital, IST National Institute for Cancer Research, University of Genoa, Genoa, Italy
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The Role of the IL-20 Subfamily in Glaucoma. Mediators Inflamm 2016; 2016:4083735. [PMID: 26903709 PMCID: PMC4745377 DOI: 10.1155/2016/4083735] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Revised: 12/04/2015] [Accepted: 12/10/2015] [Indexed: 12/23/2022] Open
Abstract
Glaucoma is a common disease that leads to loss of peripheral vision and, if left untreated, ultimately to blindness. While the exact cause(s) of glaucoma is still unknown, two leading risk factors are age and elevated intraocular pressure. Several studies suggest a possible link between glaucoma and inflammation in humans and animal models. In particular, our lab recently identified a T104M mutation in IL-20 receptor-B (IL-20RB) in primary open angle glaucoma patients from a large pedigree. Several of the interleukin- (IL-) 20 family of cytokines and receptors are expressed in ocular tissues including the trabecular meshwork, optic nerve head, and retinal ganglion cells. The DBA/2J mouse develops high intraocular pressures with age and has characteristic optic nerve defects that make it a useful glaucoma model. IL-24 expression is significantly upregulated in the retina of these mice, while IL-20RA expression in the optic nerve is downregulated following pressure-induced damage. The identification of a mutation in the IL-20RB gene in a glaucoma pedigree and changes in expression levels of IL-20 family members in the DBA/2J mouse suggest that disruption of normal IL-20 signaling in the eye may contribute to degenerative processes associated with glaucoma.
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Abstract
Selective laser trabeculoplasty is a laser treatment to treat glaucoma. It was initially indicated for open-angle glaucoma but has been proven to be efficacious for various types of glaucoma. This review article summarizes the few rare complications that can be seen with selective laser trabeculoplasty. It also makes recommendations on how to avoid these problems and how to treat patients when these rare complications arise.
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Affiliation(s)
- Julia Song
- Ophthalmology, Long Beach Memorial Medical Center, Long Beach, CA, USA
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