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Borjan I, Stanić R, Pleština-Borjan I, Pavić M, Hertzberg SNW, Znaor L, Petrovski BÉ, Petrovski G. Pseudoexfoliative Syndrome in Cataract Surgery-A Quality Register Study and Health Economic Analysis in the Split-Dalmatia County, Croatia. J Clin Med 2023; 13:38. [PMID: 38202045 PMCID: PMC10780027 DOI: 10.3390/jcm13010038] [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: 09/28/2023] [Revised: 11/26/2023] [Accepted: 12/01/2023] [Indexed: 01/12/2024] Open
Abstract
PURPOSE To investigate the impact of pseudoexfoliation (PEX) syndrome on intraoperative phacoemulsification (PHACO) parameters and assess the economic cost of PHACO surgery for cataracts in patients with and without PEX syndrome. METHODS This was a retrospective quality register study on 5889 patients (6236 eyes) who underwent PHACO cataract surgery in the Eye Clinic, Clinical Hospital Centre Split, Croatia, over a 7-year period (May 2015 to December 2022), in accordance with the Guidelines of the Helsinki Declaration and approval from the Research Ethics Committee of the University Hospital Centre Split, Croatia. Inclusion criteria were patients with either presenile or senile cataract or cataract related to PEX syndrome who undertook PHACO procedure by the same experienced surgeon using the same PHACO device (Infiniti Vision System, Alcon Laboratories, Inc., Fort Worth, TX, USA). Eyes were categorized according to PEX presence- (PEX group) or absence (Group without PEX). The following recorded data about intraoperative PHACO parameters were collected: Cumulative Dissipated Energy (CDE), Ultrasound total time, PHACO time, torsional time, aspiration time, estimated fluid used, and duration of the surgical procedure. In the economic analysis, all PHACO parameters were considered, with a specific focus on the duration of the surgical procedure, costs associated with additional medical materials and devices, complications during surgery, and surgery procedure Diagnosis-Related Group (DRG) codes. RESULTS A total of 4535 cases were eligible for inclusion in the study, 278 (6.13%) were diagnosed with PEX and 4257 (93.87%) had no PEX. Significantly higher PHACO parameters were observed in the PEX group. Similarly, a statistically significant increase in the values of all PHACO parameters was observed with the increase in nuclear lens density. Intraoperative complications were more frequent in the PEX group. Zonular weakness requiring the use of a capsular tension ring (CTR) and posterior capsular rupture occurred 30 and 13 times more often, respectively, in the PEX group. The expected cost of the PHACO procedure was found to be 1.4 times higher in patients with PEX, compared to those without PEX, for all types of nuclear cataract. CONCLUSIONS All PHACO parameters are significantly higher in patients with PEX. The costs associated with PHACO surgery for cataracts are greater for patients with PEX and are not covered by the present DRG codes, which highlights the need to accordingly adjust the DRGs for PHACO procedures in PEX patients, in order to maintain the quality of healthcare provided for these vulnerable patients.
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Affiliation(s)
- Ivan Borjan
- Clinical Department of Ophthalmology, University Hospital Center, 21000 Split, Croatia; (I.B.); (R.S.); (L.Z.)
- University of Split, School of Medicine, 21000 Split, Croatia; (I.P.-B.); (M.P.)
| | - Robert Stanić
- Clinical Department of Ophthalmology, University Hospital Center, 21000 Split, Croatia; (I.B.); (R.S.); (L.Z.)
| | - Ivna Pleština-Borjan
- University of Split, School of Medicine, 21000 Split, Croatia; (I.P.-B.); (M.P.)
| | - Maja Pavić
- University of Split, School of Medicine, 21000 Split, Croatia; (I.P.-B.); (M.P.)
| | - Silvia N. W. Hertzberg
- Center for Eye Research and Innovative Diagnostics, Department of Ophthalmology, Institute for Clinical Medicine, Faculty of Medicine, University of Oslo, 0313 Oslo, Norway; (S.N.W.H.); (B.É.P.)
| | - Ljubo Znaor
- Clinical Department of Ophthalmology, University Hospital Center, 21000 Split, Croatia; (I.B.); (R.S.); (L.Z.)
- University of Split, School of Medicine, 21000 Split, Croatia; (I.P.-B.); (M.P.)
| | - Beáta Éva Petrovski
- Center for Eye Research and Innovative Diagnostics, Department of Ophthalmology, Institute for Clinical Medicine, Faculty of Medicine, University of Oslo, 0313 Oslo, Norway; (S.N.W.H.); (B.É.P.)
| | - Goran Petrovski
- University of Split, School of Medicine, 21000 Split, Croatia; (I.P.-B.); (M.P.)
- Center for Eye Research and Innovative Diagnostics, Department of Ophthalmology, Institute for Clinical Medicine, Faculty of Medicine, University of Oslo, 0313 Oslo, Norway; (S.N.W.H.); (B.É.P.)
- Department of Ophthalmology, Oslo University Hospital, 0450 Oslo, Norway
- UKLONetwork, University St. Kliment Ohridski-Bitola, 7000 Bitola, North Macedonia
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Jeong WC, Min JY, Kang TG, Bae H. Association between pseudoexfoliation and Alzheimer's disease-related brain atrophy. PLoS One 2023; 18:e0286727. [PMID: 37289754 PMCID: PMC10249790 DOI: 10.1371/journal.pone.0286727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 05/22/2023] [Indexed: 06/10/2023] Open
Abstract
BACKGROUND/AIMS Pseudoexfoliation (PEX) syndrome is an age-related disorder characterized by the accumulation of extracellular material in the anterior eye segment. PEX pathogenesis is not fully understood, but amyloid which accumulates in the brain of patients with Alzheimer's disease (AD) is a PEX component. PEX deposition shares features with amyloid aggregation in AD, and brain atrophy is a common AD feature, with β-amyloid accumulation among contributing factors. This study investigated whether PEX syndrome is associated with AD-related brain atrophy. METHODS We reviewed the medical records of patients diagnosed with PEX at the Veterans Health Service Medical Center between January 2015 and August 2021. This retrospective cohort study included 48 patients with PEX and 48 healthy age- and sex-matched controls. Patients with PEX were divided into two groups: with and without glaucoma. The main outcome measure was brain atrophy, using a visual rating scale, and AD incidence. Brain atrophy was measured using the Scheltens scale for medial temporal atrophy, the posterior cortical atrophy scale for parietal atrophy, and the Pasquier scale for global cortical atrophy. RESULTS The percentage of participants with medial temporal atrophy was 56.3% in the PEX group and 35.4% in the control group. The global cortical atrophy and parietal atrophy scores were significantly higher in the PEX group (P<0.05), whereas the PEX and PEX glaucoma groups showed no difference. Among the 96 participants, 16 and 5 participants in the PEX and control groups, respectively, were diagnosed with dementia. Patients with PEX glaucoma tended to have lower Mini-Mental State Examination scores, indicating impaired cognitive function, than those without glaucoma. CONCLUSION PEX is associated with brain atrophy, reflecting the risk of developing AD. Patients with PEX glaucoma may present with advanced AD stages. Our results suggest that PEX may be a predictor of AD.
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Affiliation(s)
- Won Cheol Jeong
- Department of Neurology, Veterans Medical Research Institute, Veterans Health Service Medical Center, Seoul, Republic of Korea
| | - Jin-Young Min
- Veterans Medical Research Institute, Veterans Health Service Medical Center, Seoul, Republic of Korea
| | - Tae Gu Kang
- Yonsei Bom Eye Clinic, Seoul, Kyeonggi-do, Republic of Korea
| | - Heewon Bae
- Veterans Medical Research Institute, Veterans Health Service Medical Center, Seoul, Republic of Korea
- Department of Clinical Research Design & Evaluation, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University, Seoul, Republic of Korea
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Guan J, Li Z, Wumaier A, Ma Y, Xie L, Wu H, Chen R, Zhu Y, Zhuo Y. Critical role of transcriptome-wide m6A methylation in the aqueous humor of patients with pseudoexfoliation glaucoma. Exp Eye Res 2023; 231:109473. [PMID: 37061115 DOI: 10.1016/j.exer.2023.109473] [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: 01/22/2023] [Revised: 03/13/2023] [Accepted: 04/10/2023] [Indexed: 04/17/2023]
Abstract
N6-methyladenosine (m6A) modification is one of the most common types of methylation modifications in eukaryotic mRNA. However, its role in the pathogenesis of pseudoexfoliation glaucoma (PXG) has not yet been reported. To enhance understanding in this regard, we assessed the m6A methylome in the aqueous humor of patients with PXG. MeRIP-Seq and RNA-Seq analyses were performed to compare the m6A methylomes and gene expression profiles of the aqueous humor of patients with PXG with those of patients with age-related cataract (ARC). Colorimetric m6A quantification was performed to detect global m6A levels. Quantitative reverse transcription PCR confirmed the expression of m6A-related enzymes and mRNAs in both groups. Results showed significantly higher aqueous humor m6A levels in the PXG group than in the ARC group. Five m6A-related enzymes, including METTL3, YTHDC2, HNRNPA2B1, HNRNPC, and LRPPRC, were significantly up-regulated in PXG specimens. We also observed 9728 m6A-modified peaks related to 6126 gene transcripts in the PXG group, with more than 250 genes containing one m6A peak (hypomethylated or hypermethylated). The distribution of the m6A peaks was enriched in coding sequences and 3'-untranslated regions for both groups. GGAC motif structures were also significantly enriched. Bioinformatics analysis further revealed that m6A plays a critical role in extracellular matrix formation and histone deacetylation. Additionally, MMP14, ADAMTSL1, FN1, and HDAC1 showed significant changes in m6A methylation and mRNA expression in the PXG group. Therefore, m6A methylation may regulate extracellular matrix composition in PXG and METTL3 may be a pivotal regulator of this process. In the future, it would be necessary to investigate MMP14, ADAMTSL1, FN1, and HDAC1, which are potential target genes.
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Affiliation(s)
- Jieying Guan
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, 510060, China; Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, 510060, China; The Affiliated Kashi Hospital, Sun Yat-sen University, Kashi, Xinjiang, 844000, China; The First Department of Ophthalmology, The First People's Hospital of Kashi Prefecture, Kashi, Xinjiang, 844000, China.
| | - Zhidong Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, 510060, China; Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, 510060, China.
| | - Aizezi Wumaier
- The Affiliated Kashi Hospital, Sun Yat-sen University, Kashi, Xinjiang, 844000, China; The First Department of Ophthalmology, The First People's Hospital of Kashi Prefecture, Kashi, Xinjiang, 844000, China.
| | - Yuncheng Ma
- The Affiliated Kashi Hospital, Sun Yat-sen University, Kashi, Xinjiang, 844000, China; The First Department of Ophthalmology, The First People's Hospital of Kashi Prefecture, Kashi, Xinjiang, 844000, China.
| | - Lingling Xie
- The Affiliated Kashi Hospital, Sun Yat-sen University, Kashi, Xinjiang, 844000, China; The First Department of Ophthalmology, The First People's Hospital of Kashi Prefecture, Kashi, Xinjiang, 844000, China.
| | - Heping Wu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, 510060, China; Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, 510060, China.
| | - Rongxin Chen
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, 510060, China; Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, 510060, China.
| | - Yingting Zhu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, 510060, China; Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, 510060, China.
| | - Yehong Zhuo
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, 510060, China; Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, 510060, China.
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Hirbo JB, Pasutto F, Gamazon ER, Evans P, Pawar P, Berner D, Sealock J, Tao R, Straub PS, Konkashbaev AI, Breyer MA, Schlötzer-Schrehardt U, Reis A, Brantley MA, Khor CC, Joos KM, Cox NJ. Analysis of genetically determined gene expression suggests role of inflammatory processes in exfoliation syndrome. BMC Genomics 2023; 24:75. [PMID: 36797672 PMCID: PMC9936777 DOI: 10.1186/s12864-023-09179-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 02/09/2023] [Indexed: 02/18/2023] Open
Abstract
BACKGROUND Exfoliation syndrome (XFS) is an age-related systemic disorder characterized by excessive production and progressive accumulation of abnormal extracellular material, with pathognomonic ocular manifestations. It is the most common cause of secondary glaucoma, resulting in widespread global blindness. The largest global meta-analysis of XFS in 123,457 multi-ethnic individuals from 24 countries identified seven loci with the strongest association signal in chr15q22-25 region near LOXL1. Expression analysis have so far correlated coding and a few non-coding variants in the region with LOXL1 expression levels, but functional effects of these variants is unclear. We hypothesize that analysis of the contribution of the genetically determined component of gene expression to XFS risk can provide a powerful method to elucidate potential roles of additional genes and clarify biology that underlie XFS. RESULTS Transcriptomic Wide Association Studies (TWAS) using PrediXcan models trained in 48 GTEx tissues leveraging on results from the multi-ethnic and European ancestry GWAS were performed. To eliminate the possibility of false-positive results due to Linkage Disequilibrium (LD) contamination, we i) performed PrediXcan analysis in reduced models removing variants in LD with LOXL1 missense variants associated with XFS, and variants in LOXL1 models in both multiethnic and European ancestry individuals, ii) conducted conditional analysis of the significant signals in European ancestry individuals, and iii) filtered signals based on correlated gene expression, LD and shared eQTLs, iv) conducted expression validation analysis in human iris tissues. We observed twenty-eight genes in chr15q22-25 region that showed statistically significant associations, which were whittled down to ten genes after statistical validations. In experimental analysis, mRNA transcript levels for ARID3B, CD276, LOXL1, NEO1, SCAMP2, and UBL7 were significantly decreased in iris tissues from XFS patients compared to control samples. TWAS genes for XFS were significantly enriched for genes associated with inflammatory conditions. We also observed a higher incidence of XFS comorbidity with inflammatory and connective tissue diseases. CONCLUSION Our results implicate a role for connective tissues and inflammation pathways in the etiology of XFS. Targeting the inflammatory pathway may be a potential therapeutic option to reduce progression in XFS.
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Affiliation(s)
- Jibril B. Hirbo
- grid.152326.10000 0001 2264 7217Genetic Medicine, Vanderbilt University School of Medicine, Nashville, TN 37232 USA ,Vanderbilt Genetics Institute, Nashville, TN 37232 USA
| | - Francesca Pasutto
- grid.5330.50000 0001 2107 3311Institute of Human Genetics, Friedrich-Alexander-Universität Erlangen-Nürnberg FAU, 91054 Erlangen, Germany
| | - Eric R. Gamazon
- grid.152326.10000 0001 2264 7217Genetic Medicine, Vanderbilt University School of Medicine, Nashville, TN 37232 USA ,Vanderbilt Genetics Institute, Nashville, TN 37232 USA ,grid.5335.00000000121885934Clare Hall and MRC Epidemiology Unit, University of Cambridge, Cambridge, CB2 0SL UK
| | - Patrick Evans
- grid.152326.10000 0001 2264 7217Genetic Medicine, Vanderbilt University School of Medicine, Nashville, TN 37232 USA
| | - Priyanka Pawar
- grid.412807.80000 0004 1936 9916Vanderbilt Eye Institute, Vanderbilt University Medical Center, Nashville, TN 37232 USA
| | - Daniel Berner
- grid.5330.50000 0001 2107 3311Department of Ophthalmology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, 91054 Erlangen, Germany
| | - Julia Sealock
- grid.152326.10000 0001 2264 7217Genetic Medicine, Vanderbilt University School of Medicine, Nashville, TN 37232 USA
| | - Ran Tao
- grid.152326.10000 0001 2264 7217Biostatistics, Vanderbilt University School of Medicine, Nashville, TN 37232 USA
| | - Peter S. Straub
- grid.152326.10000 0001 2264 7217Genetic Medicine, Vanderbilt University School of Medicine, Nashville, TN 37232 USA
| | - Anuar I. Konkashbaev
- grid.152326.10000 0001 2264 7217Genetic Medicine, Vanderbilt University School of Medicine, Nashville, TN 37232 USA
| | - Max A. Breyer
- grid.152326.10000 0001 2264 7217Genetic Medicine, Vanderbilt University School of Medicine, Nashville, TN 37232 USA
| | - Ursula Schlötzer-Schrehardt
- grid.5330.50000 0001 2107 3311Department of Ophthalmology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, 91054 Erlangen, Germany
| | - André Reis
- grid.5330.50000 0001 2107 3311Institute of Human Genetics, Friedrich-Alexander-Universität Erlangen-Nürnberg FAU, 91054 Erlangen, Germany
| | - Milam A. Brantley
- grid.5335.00000000121885934Clare Hall and MRC Epidemiology Unit, University of Cambridge, Cambridge, CB2 0SL UK
| | - Chiea C. Khor
- grid.418377.e0000 0004 0620 715XGenome Institute of Singapore, 60 Biopolis St, Singapore, 138672 Singapore
| | - Karen M. Joos
- grid.412807.80000 0004 1936 9916Vanderbilt Eye Institute, Vanderbilt University Medical Center, Nashville, TN 37232 USA
| | - Nancy J. Cox
- grid.152326.10000 0001 2264 7217Genetic Medicine, Vanderbilt University School of Medicine, Nashville, TN 37232 USA ,Vanderbilt Genetics Institute, Nashville, TN 37232 USA
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