Pseudoexfoliation Glaucoma

[Spatial contrast sensitivity in patients with primary open-angle glaucoma and ocular hypertension]

Up to now, there has not been a comparison of spatial contrast sensitivity (SCS) in patients with primary and pseudoexfoliation open-angle glaucoma (POAG; PEG) and ophthalmic hypertension (OH).

PURPOSE

To study the characteristics of SCS in patients with POAG, PEG (as well as in the paired eye without glaucoma) and OH.

MATERIAL AND METHODS

The work was performed in the period from 2011 to July 2017. Analytical, observational case-control study data was analyzed. The study included 1380 patients under dynamic observation; in accordance with inclusion and non-inclusion criteria, 290 patients (540 eyes) with POAG, PEG, OH, as well as healthy people were included in the study. SCS was measured using 'Zebra v 3.0' software developed by the laboratory of clinical physiology of vision named after S.V. Kravkova in collaboration with 'Astroinform SPE' LLC. Patients were shown vertical achromatic (black and white) and colored (red, green, and blue) gratings of specific spatial frequencies (0.5; 1; 2; 4; 8; 16 cycles/degree). Among the patients of the study, 243 (83%) were female and 47 (17%) were male. The average age of all patients at the time of inclusion in the study was 67.75 (62.8; 74.5); 67.84±8.7 years.

RESULTS

The study revealed an increase of SCS in patients with OH and their tendency for a slight increase in the contralateral eye with unilateral PEG in comparison with measurements taken from patients of POAG and PEG groups.

CONCLUSION

The revealed increase of SCS is likely to be a consequence of increased or preserved hemodynamic characteristics in the vessels of the eye and orbit in patients with hypertension and in the contralateral eye in unilateral glaucoma, as described in our previous publications. At the same time, generalized changes in the vascular wall in patients with 'PEG-' on the paired eye only predetermine a tendency for an increase of SCS indices.

Ocular clinical profile of patients with pseudoexfoliation syndrome in a tertiary eye care center in South India

Purpose:

To study the clinical profile of pseudoexfoliation (PEX) syndrome in a hospital setting.

Materials and Methods:

A case series of patients with PEX, with and without glaucoma attending the general ophthalmology clinic of a tertiary care center in South India. All patients underwent a complete ophthalmologic evaluation including recording diurnal variation of tension (DVT), gonioscopy and visual field assessment.

Results:

The study cohort comprised 529 patients (752 eyes). There were 296 (56%) females. The highest number of patients (261 patients) was from the age group between 60 and 69 years. Of 752 eyes, 57.8% eyes had unilateral PEX and 72% had established PEX. Gonioscopy showed open angles in 98.1% of eyes. Intraocular pressure (IOP) greater than 21 mmHg in at least 1 of 4 measurements was recorded in 5.7% eyes. DVT was normal in 96.4% of unilateral PEX eyes, similar to fellow non-PEX eyes. Pseudoexfoliation glaucoma occurred in 1.9% of eyes and 4.7% of eyes were glaucoma suspects. There was no correlation between the stage of PEX and increased IOP. Mean central corneal thickness of PEX eyes was 522 ± 27μ. Pupillary dilatation in 90.5% eyes with early PEX was ≥ 7 mm.

Conclusions:

A small percentage of PEX eyes had raised IOP, and the number of eyes with glaucomatous optic neuropathy was even lower. PEX eyes did not demonstrate wide fluctuations in IOP. No correlation was found between raised IOP and stage of PEX. There was good pupillary dilatation in early stage PEX eyes suggesting that all PEX eyes may not have poor pupillary dilatation and related complications.

Comparative effects of TGF-β1 and TGF-β2 on extracellular matrix production, proliferation, migration, and collagen contraction of human Tenon's capsule fibroblasts in pseudoexfoliation and primary open-angle glaucoma

PURPOSE

To comparatively investigate the effects of TGF-beta(1) and TGF-beta(2) on extracellular matrix production, proliferation, migration, and collagen contraction of cultured human Tenon's capsule fibroblasts derived from patients with pseudoexfoliation (PEX) syndrome, PEX glaucoma, primary open-angle glaucoma (POAG), and cataract.

METHODS

Tenon's capsule fibroblasts obtained from four groups of patients were cultured and stimulated with different concentrations (0.1-10 ng ml(-1)) of TGF-beta(1) or TGF-beta(2) for up to 14 days. Cell proliferation was determined with the WST-1 colorimetric assay, cell migration by using the Transwell assay system, and collagen contraction by computerised analysis of three-dimensional collagen lattices and immunohistochemistry for alpha-smooth muscle actin expression. Expression and synthesis of extracellular matrix components (fibronectin, collagen types I and III) was assessed by enzyme-linked immunosorbent assays, by real-time RT-PCR, and by transmission electron microscopy.

RESULTS

Both TGF-beta(1) and TGF-beta(2) in pathophysiological concentrations of 0.1-5 ng ml(-1) stimulated cell proliferation, migration, collagen contraction, alpha-smooth muscle actin expression as well as mRNA expression and secretion of fibronectin, collagen type I, and collagen type III by Tenon's fibroblasts derived from all groups of patients. TGF-beta stimulation occurred in a concentration-dependent manner with different peak activities associated with different fibroblast functions. There was some variability among the different groups of patients with an increased response of cells derived from PEX and POAG patients as compared to cataract patients. Although no statistically significant differences were found between both TGF-beta isoforms, TGF-beta(1) had a more pronounced stimulatory effect on expression and synthesis of extracellular matrix components including the production of elastic microfibrils, particularly in cells derived from patients with PEX syndrome/glaucoma.

CONCLUSIONS

These findings suggest a significant contribution of TGF-beta(1) in addition to TGF-beta(2) to the conjunctival scarring process following glaucoma filtration surgery. Due to its pronounced fibrogenic potential, TGF-beta(1) may become another focus for targeting drug therapy, particularly in patients with PEX glaucoma.