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Vallée R, Meduri E, Vallée JN, Lallouette A, Haffane Z, Paillard A, Mansouri K, Mermoud A. Predictive biomarkers of intra-ocular pressure decrease after cataract surgery associated with trabecular washout in patients with pseudo exfoliative glaucoma. Sci Rep 2024; 14:13567. [PMID: 38866840 PMCID: PMC11169244 DOI: 10.1038/s41598-024-53893-5] [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: 07/28/2023] [Accepted: 02/06/2024] [Indexed: 06/14/2024] Open
Abstract
To investigate biomarkers of intra-ocular pressure (IOP) decrease after cataract surgery with trabecular washout in pseudo-exfoliative (PEX) glaucoma. A single-center observational prospective study in PEX glaucoma patients undergoing cataract surgery with trabecular washout (Goniowash) was performed from 2018 to 2021. Age, gender, visual acuity, IOP, endothelial cell count, central corneal thickness, medications, were collected over 16-month follow-up. Multivariable binomial regression models were implemented. 54 eyes (35 subjects) were included. Mean preoperative IOP (IOPBL) was 15.9 ± 3.5 mmHg. Postoperative IOP reduction was significant at 1-month and throughout follow-up (p < 0.01, respectively). IOPBL was a predictive biomarker inversely correlated to IOP decrease throughout follow-up (p < 0.001). At 1 and 12 months of follow-up, IOP decrease concerned 31 (57.4%) and 34 (63.0%) eyes with an average IOP decrease of 17.5% (from 17.6 ± 3.1 to 14.3 ± 2.2 mmHg) and 23.0% (from 17.7 ± 2.8 to 13.5 ± 2.6 mmHg), respectively. Performance (AUC) of IOPBL was 0.85 and 0.94 (p < 0.0001, respectively), with IOPBL threshold ≥ 15 mmHg for 82.1% and 96.8% sensitivity, 84.2% and 75.0% specificity, 1.84 and 3.91 IOP decrease odds-ratio, respectively. All PEX glaucoma patients with IOPBL greater than or equal to the average general population IOP were likely to achieve a significant sustainable postoperative IOP decrease.
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Affiliation(s)
- Rodolphe Vallée
- Diagnostic and Functional Neuroradiology and Brain stimulation Department, 15-20 National Vision Hospital - Paris University Hospital Center, University of PARIS-SACLAY - UVSQ, Paris, France.
- Mathematics and Applications Laboratory (LMA), CNRS UMR7348, LRCOM i3M-DACTIMMIS, University of Poitiers, Poitiers, France.
- Glaucoma Research Center, Montchoisi Clinic, Swiss Visio, Lausanne, Switzerland.
| | - Enrico Meduri
- Glaucoma Research Center, Montchoisi Clinic, Swiss Visio, Lausanne, Switzerland
| | - Jean-Noël Vallée
- Diagnostic and Functional Neuroradiology and Brain stimulation Department, 15-20 National Vision Hospital - Paris University Hospital Center, University of PARIS-SACLAY - UVSQ, Paris, France
| | - Athena Lallouette
- Glaucoma Research Center, Montchoisi Clinic, Swiss Visio, Lausanne, Switzerland
| | - Zakarya Haffane
- Glaucoma Research Center, Montchoisi Clinic, Swiss Visio, Lausanne, Switzerland
| | - Archibald Paillard
- Glaucoma Research Center, Montchoisi Clinic, Swiss Visio, Lausanne, Switzerland
| | - Kaweh Mansouri
- Glaucoma Research Center, Montchoisi Clinic, Swiss Visio, Lausanne, Switzerland
- Ophthalmology Department, Colorado University Medical School, Denver, CO, USA
| | - André Mermoud
- Glaucoma Research Center, Montchoisi Clinic, Swiss Visio, Lausanne, Switzerland
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Kang E, Park JH, Yoo C, Kim YY. Comparison of intraocular pressure fluctuation and glaucoma progression rate between phakic and pseudophakic eyes in pseudoexfoliation glaucoma. Sci Rep 2024; 14:6. [PMID: 38168116 PMCID: PMC10761949 DOI: 10.1038/s41598-023-49099-w] [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: 07/26/2023] [Accepted: 12/04/2023] [Indexed: 01/05/2024] Open
Abstract
The management of patients with concurrent pseudoexfoliation glaucoma (PXG) and cataract is challenging given its worse prognosis compared to other glaucoma types and the increased risk associated with cataract surgery. In this retrospective study, we investigated the long-term outcomes of cataract surgery in patients with PXG. We enrolled patients with PXG who had undergone cataract surgery at least 2 years previously and compared them with mean deviation (MD) matched patients with phakic eyes. The results showed that both groups experienced a decrease in MD, with the group of pseudophakic eyes exhibiting a significantly higher rate of decline (-2.15 ± 2.66 dB/year vs. -0.86 ± 0.95 dB/year; P = 0.040). Similarly, there was a trend towards more rapid thinning of the retinal nerve fiber layer in the pseudophakic group (-2.92 ± 2.34 μm/year vs. -1.79 ± 1.71 μm/year; P = 0.074). No significant differences in the intraocular pressure parameters were observed between the two groups. Multivariate analysis revealed that pseudophakic lens status was significantly associated with a faster rate of MD decline in patients with PXG (regression coefficient, -1.391; P = 0.022). These findings underscore the importance of close monitoring of patients with pseudophakic PXG to effectively manage glaucoma progression.
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Affiliation(s)
- Edward Kang
- Department of Ophthalmology, Korea University College of Medicine, Seoul, Korea
| | - Ji-Hye Park
- Department of Ophthalmology, Korea University College of Medicine, Seoul, Korea.
- Department of Ophthalmology, Korea University Ansan Hospital, 123 Jeokgeum-ro, Danwon-gu, Ansan-si, 15355, Gyeonggi-do, Korea.
| | - Chungkwon Yoo
- Department of Ophthalmology, Korea University College of Medicine, Seoul, Korea
| | - Yong Yeon Kim
- Department of Ophthalmology, Korea University College of Medicine, Seoul, Korea
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Maltsev DS, Kulikov AN, Kazak AA, Burnasheva MA, Vasiliev AA. Efficacy and Safety of Cataract Surgery-Assisted Selective Laser Trabeculoplasty: A Pilot Study. J Curr Ophthalmol 2023; 35:23-28. [PMID: 37680297 PMCID: PMC10481979 DOI: 10.4103/joco.joco_23_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Revised: 04/16/2023] [Accepted: 04/16/2023] [Indexed: 09/09/2023] Open
Abstract
Purpose To evaluate the intraocular pressure (IOP)-lowering effect and safety of selective laser trabeculoplasty (SLT) with same-day cataract surgery which we named cataract surgery-assisted selective laser trabeculoplasty (CAST) compared to conventional SLT and cataract surgery as standalone procedures. Methods Patients with primary open-angle glaucoma and cataract were included in this prospective interventional study. All patients received either a CAST procedure, standard SLT, or standard cataract surgery. IOP was assessed at baseline and at months 1, 2, 3, and 6. Topical IOP-lowering medication was canceled during the follow-up if necessary. Results Twenty-nine, twenty-seven, and thirty eyes received the CAST procedure, SLT, and standard cataract surgery, respectively. There was no statistically significant difference in age, male-to-female ratio, or baseline IOP between groups (P > 0.05). The mean IOP reduction at 6 months after the CAST procedure, SLT, and standard cataract surgery was -7.3 ± 3.8 mmHg, -3.8 ± 3.7 mmHg, and -0.7 ± 3.7 mmHg, respectively (P < 0.001). Eleven out of 29 (37.9%) and 5 out of 27 (18.5%) eyes achieved 30% reduction of IOP after the CAST procedure and SLT, respectively. No eyes achieved 30% reduction of IOP at the end of the follow-up in cataract surgery group. The median number of IOP-lowering medications cancelled after the CAST procedure was 1.0 (range, 0-3). No antiglaucoma medication was cancelled after SLT or cataract surgery. No adverse events were registered in patients who received the CAST procedure. Conclusion At 6-month follow-up, the CAST procedure had a significantly greater IOP-lowering effect and reduction of topical antiglaucoma medication than SLT or cataract surgery alone.
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Affiliation(s)
- Dmitrii S. Maltsev
- Department of Ophthalmology, Military Medical Academy, St. Petersburg, Russia
| | - Alexei N. Kulikov
- Department of Ophthalmology, Military Medical Academy, St. Petersburg, Russia
| | - Alina A. Kazak
- Department of Ophthalmology, Military Medical Academy, St. Petersburg, Russia
| | - Maria A. Burnasheva
- Department of Ophthalmology, Military Medical Academy, St. Petersburg, Russia
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Ghaffari Sharaf M, Waduthanthri KD, Crichton A, Damji KF, Unsworth LD. Towards preventing exfoliation glaucoma by targeting and removing fibrillar aggregates associated with exfoliation syndrome. J Nanobiotechnology 2022; 20:459. [PMID: 36303134 DOI: 10.1186/s12951-022-01665-6] [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: 03/18/2022] [Accepted: 10/02/2022] [Indexed: 11/10/2022] Open
Abstract
Exfoliation syndrome presents as an accumulation of insoluble fibrillar aggregates that commonly correlates with age and causes ocular complications, most notably open-angle glaucoma. Despite advances in understanding the pathogenesis and risk factors associated with exfoliation syndrome, there has been no significant progress in curative pharmacotherapy of this disease. It is thought that the ability to target the fibrillar aggregates associated with exfoliation may offer a new therapeutic approach, facilitating their direct removal from affected tissues. Phage display techniques yielded two peptides (LPSYNLHPHVPP, IPLLNPGSMQLS) that could differentiate between exfoliative and non-affected regions of the human lens capsule. These peptides were conjugated to magnetic particles using click chemistry to investigate their ability in targeting and removing exfoliation materials from the anterior human lens capsule. The behavior of the fibrillar materials upon binding to these magnetic particles was assessed using magnetic pins and rotating magnetic fields of various strengths. Ex vivo studies showed that the magnetic particle-peptide conjugates could generate enough mechanical force to remove large aggregates of exfoliation materials from the lens capsule when exposed to a low-frequency rotating magnetic field (5000 G, 20 Hz). Biocompatibility of targeting peptides with and without conjugated magnetic particles was confirmed using MTT cell toxicity assay, live/dead cell viability assay, and DNA fragmentation studies on primary cultured human trabecular meshwork cells. This is a novel, minimally invasive, therapeutic approach for the treatment of exfoliation glaucoma via the targeting and removal of exfoliation materials that could be applied to all tissues within the anterior segment of the eye.
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Affiliation(s)
- Mehdi Ghaffari Sharaf
- Department of Chemical and Materials Engineering, University of Alberta, Edmonton, AB, Canada
| | - Kosala D Waduthanthri
- Department of Chemical and Materials Engineering, University of Alberta, Edmonton, AB, Canada
| | - Andrew Crichton
- Department of Ophthalmology, University of Calgary, Calgary, Canada
| | - Karim F Damji
- Department of Ophthalmology and Visual Sciences, University of Alberta, Edmonton, AB, Canada
| | - Larry D Unsworth
- Department of Chemical and Materials Engineering, University of Alberta, Edmonton, AB, Canada.
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Pratte EL, Cho J, Landreneau JR, Hirabayashi MT, An JA. Predictive Factors of Outcomes in Kahook Dual Blade Excisional Goniotomy Combined with Phacoemulsification. J Curr Glaucoma Pract 2022; 16:47-52. [PMID: 36060044 PMCID: PMC9385392 DOI: 10.5005/jp-journals-10078-1313] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Aim To identify factors that were significant predictors of Kahook Dual Blade (KDB) excisional goniotomy outcomes. Materials and methods One hundred and thirty-two eyes from 99 adult glaucoma patients who underwent combined KDB and phacoemulsification (KDB-phaco) with a minimum 6-month follow-up were assessed for baseline patient characteristics to determine correlation to the success of KDB-phaco at 6 and 12 months postoperatively. Success was defined as ≥20% intraocular pressure (IOP) reduction or ≥1 medication reduction as well as IOP ≤18 mm Hg without any additional IOP-lowering procedures after KDB-phaco. Results 63.6% (84/132) and 46.1% (41/89) of cases were successful at the 6- and 12-month follow-ups, respectively. KDB-phaco reduced patient's preoperative IOP (in mm Hg) from 17.6 ± 4.6 to 14.9 ± 3.2 at 6 months (15.3%, p < 0.001) and 15.4 ± 4.7 at 12 months (12.5%, p = 0.001). KDB-phaco reduced patient's preoperative IOP-lowering medications from 2 ± 1.2 to 1.1 ± 1.2 at 6 months (45%, p < 0.001) and 1.32 ± 1.3 at 12 months (34%, p < 0.001). At 6 months, patients on >1 IOP lowering medication had a greater chance of meeting our success criteria (p = 0.037). Visually significant postoperative hyphema was not associated with the use of anticoagulation (p = 0.943) but was significantly associated with postoperative day 1 IOP ≤ 10 mm Hg (p = 0.011). Conclusion Patients who underwent KDB-phaco significantly reduced their IOP and medication burden at both 6 and 12 months compared with their baseline preoperative values. KDB-phaco outcome was associated with higher baseline IOP-lowering medications and increased rate of hyphema was associated with lower postoperative day 1 IOP, regardless of anticoagulation status. Age, ethnicity, prior laser trabeculoplasty, type and severity of glaucoma, and baseline preoperative IOP were not associated with surgical success. Clinical significance Patients with a higher number of baseline medications may experience a greater probability of success following KDB-phaco. How to cite this article Pratte EL, Cho J, Landreneau JR, et al. Predictive Factors of Outcomes in Kahook Dual Blade Excisional Goniotomy Combined with Phacoemulsification. J Curr Glaucoma Pract 2022;16(1):47-52.
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Affiliation(s)
- Eli L Pratte
- University of Missouri School of Medicine, Columbia, MO, USA
| | - Junsang Cho
- University of Missouri School of Medicine, Columbia, MO, USA
| | - James R Landreneau
- Department of Ophthalmology, University of Missouri School of Medicine, Columbia, MO, USA; Mason Eye Institute East, Columbia, MO, USA
| | - Matthew T Hirabayashi
- Department of Ophthalmology, University of Missouri School of Medicine, Columbia, MO, USA; Mason Eye Institute East, Columbia, MO, USA
| | - Jella A An
- Department of Ophthalmology, University of Missouri School of Medicine, Columbia, MO, USA; Mason Eye Institute East, Columbia MO, USA; Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore MD, USA
- Jella A An, Department of Ophthalmology, University of Missouri School of Medicine, Columbia, MO, USA; Mason Eye Institute East, Columbia, MO, USA; Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore MD, USA, Phone: +1 573-884-7156, e-mail:
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