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Song Y, Lin F, Lv A, Zhang Y, Lu L, Xie L, Tang G, Yuan H, Yang Y, Xu J, Lu P, Xiao M, Zhu X, Yan X, Song W, Li X, Zhang H, Li F, Wang Z, Jin L, Gao X, Liang X, Zhou M, Zhao X, Zhang Y, Chen W, Wang N, Tham CC, Barton K, Park KH, Aung T, Weinreb RN, Tang L, Fan S, Lam DSC, Zhang X. Phacogoniotomy versus phacotrabeculectomy for advanced primary angle-closure glaucoma with cataract: A randomized non-inferiority trial. Asia Pac J Ophthalmol (Phila) 2024; 13:100033. [PMID: 38383075 DOI: 10.1016/j.apjo.2023.100033] [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: 11/09/2023] [Revised: 12/16/2023] [Accepted: 12/19/2023] [Indexed: 02/23/2024] Open
Abstract
PURPOSE To investigate the effectiveness and safety of phacogoniotomy versus phacotrabeculectomy (PVP) among patients with advanced primary angle-closure glaucoma (PACG) and cataracts. DESIGN Multicenter, randomized controlled, non-inferiority trial. METHODS A total of 124 patients (124 eyes) with advanced PACG and cataracts were enrolled, with 65 in the phacogoniotomy group and 59 in the phacotrabeculectomy group. Patients were followed up for 12 months with standardized evaluations. The primary outcome was the reduction in intraocular pressure (IOP) from baseline to 12 months postoperatively, of which a non-inferiority margin of 4 mmHg was evaluated. Secondary outcomes included the cumulative surgical success rate, postoperative complications, and changes in the number of glaucoma medications. RESULTS After 12 months, phacogoniotomy demonstrated non-inferiority to phacotrabeculectomy in terms of IOP reduction, with mean IOP reductions of - 26.1 mmHg and - 25.7 mmHg (P = 0.383), respectively, from baseline values of around 40 mmHg. Both groups experienced a significant reduction in the mean number of medications used postoperatively (P < 0.001). The cumulative success rate was comparable between the groups (P = 0.890). However, phacogoniotomy had a lower rate of postoperative complications and interventions (12.3% and 4.6%) compared to phacotrabeculectomy (23.7% and 20.3% respectively). The phacogoniotomy group reported shorter surgery time (22.1 ± 6.5 vs. 38.8 ± 11.1 min; P = 0.030) and higher quality of life (EQ-5D-5 L) improvement at 12 months (7.0 ± 11.5 vs. 3.0 ± 12.9, P = 0.010) than the phacotrabeculectomy group. CONCLUSIONS Phacogoniotomy was non-inferior to phacotrabeculectomy in terms of IOP reduction for advanced PACG and cataracts. Additionally, phacogoniotomy provided a shorter surgical time, lower postoperative complication rate, fewer postoperative interventions, and better postoperative quality of life.
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Affiliation(s)
- Yunhe Song
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou 510060, China
| | - Fengbin Lin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou 510060, China
| | - Aiguo Lv
- Handan City Eye Hospital (The Third Hospital of Handan), Handan 056001, China
| | - Yao Zhang
- Department of Ophthalmology, West China Hospital of Sichuan University, Chengdu, Sichuan Province 610041, China
| | - Lan Lu
- Department of Ophthalmology, Fujian Medical University Union Hospital, Fuzhou, Fujian Province 350001, China
| | - Lin Xie
- Department of Ophthalmology, the Third Affiliated Hospital of Chongqing Medical University, Chongqing 401120, China
| | - Guangxian Tang
- Department of Ophthalmology, Shijiazhuang People's Hospital, Hebei Province, 050000, China
| | - Huiping Yuan
- Department of Ophthalmology, the 2nd Affiliated Hospital, Harbin Medical University, Harbin, Heilongjiang 150086, China
| | - Yangfan Yang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou 510060, China
| | - Jiangang Xu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou 510060, China
| | - Ping Lu
- Handan City Eye Hospital (The Third Hospital of Handan), Handan 056001, China
| | - Meichun Xiao
- Department of Ophthalmology, Fujian Medical University Union Hospital, Fuzhou, Fujian Province 350001, China
| | - Xiaomin Zhu
- Department of Ophthalmology, the Third Affiliated Hospital of Chongqing Medical University, Chongqing 401120, China
| | - Xiaowei Yan
- Department of Ophthalmology, Shijiazhuang People's Hospital, Hebei Province, 050000, China
| | - Wulian Song
- Department of Ophthalmology, the 2nd Affiliated Hospital, Harbin Medical University, Harbin, Heilongjiang 150086, China
| | - Xiaoyan Li
- Handan City Eye Hospital (The Third Hospital of Handan), Handan 056001, China
| | - Hengli Zhang
- Department of Ophthalmology, Shijiazhuang People's Hospital, Hebei Province, 050000, China
| | - Fei Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou 510060, China
| | - Zhenyu Wang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou 510060, China
| | - Ling Jin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou 510060, China
| | - Xinbo Gao
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou 510060, China
| | - Xiaohong Liang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou 510060, China
| | - Minwen Zhou
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai 200080, China
| | - Xiaohuan Zhao
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai 200080, China
| | - Yu Zhang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou 510060, China
| | - Weirong Chen
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou 510060, China
| | - Ningli Wang
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Clement C Tham
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region of China
| | - Keith Barton
- NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, UCL Institute of Ophthalmology, London, UK
| | - Ki Ho Park
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Tin Aung
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore, Singapore
| | - Robert N Weinreb
- Hamilton Glaucoma Center, Viterbi Family Department of Ophthalmology, Shiley Eye Institute, University of California, San Diego, CA, USA
| | - Li Tang
- Department of Ophthalmology, West China Hospital of Sichuan University, Chengdu, Sichuan Province 610041, China.
| | - Sujie Fan
- Handan City Eye Hospital (The Third Hospital of Handan), Handan 056001, China.
| | - Dennis S C Lam
- The International Eye Research Institute, the Chinese University of Hong Kong (Shenzhen), Shenzhen, China.
| | - Xiulan Zhang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou 510060, China.
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2
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Buffault J, Brignole-Baudouin F, Labbé A, Baudouin C. An Overview of Current Glaucomatous Trabecular Meshwork Models. Curr Eye Res 2023; 48:1089-1099. [PMID: 37661784 DOI: 10.1080/02713683.2023.2253378] [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: 04/04/2023] [Revised: 07/26/2023] [Accepted: 08/25/2023] [Indexed: 09/05/2023]
Abstract
PURPOSE To provide an overview of the existing alternative models for studying trabecular meshwork (TM). METHODS Literature review. RESULTS The TM is a complex tissue that regulates aqueous humor outflow from the eye. Dysfunction of the TM is a major contributor to the pathogenesis of open-angle glaucoma, a leading cause of irreversible blindness worldwide. The TM is a porous structure composed of trabecular meshwork cells (TMC) within a multi-layered extracellular matrix (ECM). Although dysregulation of the outflow throughout the TM represents the first step in the disease process, the underlying mechanisms of TM degeneration associate cell loss and accumulation of ECM, but remain incompletely understood, and drugs targeting the TM are limited. Therefore, experimental models of glaucomatous trabeculopathy are necessary for preclinical screening, to advance research on this disease's pathophysiology, and to develop new therapeutic strategies targeting the TM. Traditional animal models have been used extensively, albeit with inherent limitations, including ethical concerns and limited translatability to humans. Consequently, there has been an increasing focus on developing alternative in vitro models to study the TM. Recent advancements in three-dimensional cell culture and tissue engineering are still in their early stages and do not yet fully reflect the complexity of the outflow pathway. However, they have shown promise in reducing reliance on animal experimentation in certain aspects of glaucoma research. CONCLUSION This review provides an overview of the existing alternative models for studying TM and their potential for advancing research on the pathophysiology of open-angle glaucoma and developing new therapeutic strategies.
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Affiliation(s)
- Juliette Buffault
- Department of Ophthalmology III, Quinze-Vingts National Ophthalmology Hospital, IHU Foresight, Paris, France
- Institut de la Vision, Sorbonne Université, INSERM, CNRS, IHU Foresight, Paris, France
- Department of Ophthalmology, Ambroise Paré Hospital, APHP, Université de Versailles Saint-Quentin-en-Yvelines, Boulogne-Billancourt, France
| | - Françoise Brignole-Baudouin
- Institut de la Vision, Sorbonne Université, INSERM, CNRS, IHU Foresight, Paris, France
- Department of Biology, Quinze-Vingts National Ophthalmology Hospital, IHU Foresight, Paris, France
| | - Antoine Labbé
- Department of Ophthalmology III, Quinze-Vingts National Ophthalmology Hospital, IHU Foresight, Paris, France
- Institut de la Vision, Sorbonne Université, INSERM, CNRS, IHU Foresight, Paris, France
- Department of Ophthalmology, Ambroise Paré Hospital, APHP, Université de Versailles Saint-Quentin-en-Yvelines, Boulogne-Billancourt, France
| | - Christophe Baudouin
- Department of Ophthalmology III, Quinze-Vingts National Ophthalmology Hospital, IHU Foresight, Paris, France
- Institut de la Vision, Sorbonne Université, INSERM, CNRS, IHU Foresight, Paris, France
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3
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Lin F, Nie X, Shi J, Song Y, Lv A, Li X, Lu P, Zhang H, Jin L, Tang G, Fan S, Weinreb RN, Zhang X. Safety and Efficacy of Goniotomy following Failed Surgery for Glaucoma. J Glaucoma 2023; 32:942-947. [PMID: 37725785 DOI: 10.1097/ijg.0000000000002301] [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: 03/15/2023] [Accepted: 08/09/2023] [Indexed: 09/21/2023]
Abstract
PRCIS Goniotomy (GT) is an alternative surgery for patients with prior failed surgery for glaucoma. PURPOSE To evaluate the efficacy and safety of GT in patients with prior failed surgery for glaucoma. MATERIALS AND METHODS A prospective, observational multicentered study was performed for patients who underwent GT with prior single or multiple surgery for glaucoma. Outcome measures included intraocular pressure (IOP) change, best-corrected visual acuity change, ocular hypotensive medication use, and occurrence of adverse events through 12 months. Complete success was defined as a postoperative IOP within 6-18 mmHg and a 20% reduction from baseline without ocular hypotensive medications. Qualified success was the same as the definition of complete success, except for postoperative use of medication. Logistic regression models were used to investigate the potential factors for surgical success. RESULTS A total of 38 eyes of 34 patients were included. Twenty-three eyes had only 1 prior surgery, 13 eyes had 2 prior surgeries, 1 eye had 3 prior surgeries, and 1 eye had 4 prior surgeries. At month 12, there was complete success in 42.1% of the eyes and qualified success in 78.9% of the eyes. Preoperatively, the mean IOP was 29.4±6.9 mmHg and the median number of glaucoma medications used was 3.0 (2.0, 4.0); this decreased to 16.7±3.6 mmHg (43.2% reduction; P <0.001) and 2.0 (0.0, 3.0) ( P <0.001) at month 12, respectively. The most common complications included hyphema (13.2%), IOP spike (7.9%), and corneal edema (5.2%). Older age significantly contributed to surgical success. CONCLUSIONS GT seems to be a safe and effective procedure for patients with prior failed surgery for glaucoma.
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Affiliation(s)
- Fengbin Lin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou
| | - Xin Nie
- Department of Ophthalmology, Chongqing General Hospital, Chongqing
| | | | - Yunhe Song
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou
| | - Aiguo Lv
- Handan City Eye Hospital (The Third Hospital of Handan), Handan
| | - Xiaoyan Li
- Handan City Eye Hospital (The Third Hospital of Handan), Handan
| | - Ping Lu
- Handan City Eye Hospital (The Third Hospital of Handan), Handan
| | - Hengli Zhang
- Department of Ophthalmology, Shijiazhuang People's Hospital, Hebei, China
| | - Ling Jin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou
| | - Guangxian Tang
- Department of Ophthalmology, Shijiazhuang People's Hospital, Hebei, China
| | - Sujie Fan
- Handan City Eye Hospital (The Third Hospital of Handan), Handan
| | - Robert N Weinreb
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, CA
| | - Xiulan Zhang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou
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4
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O’Callaghan J, Delaney C, O’Connor M, van Batenburg-Sherwood J, Schicht M, Lütjen-Drecoll E, Hudson N, Ni Dhubhghaill S, Humphries P, Stanley C, Keravala A, Chalberg T, Lawrence MS, Campbell M. Matrix metalloproteinase-3 (MMP-3)-mediated gene therapy for glaucoma. SCIENCE ADVANCES 2023; 9:eadf6537. [PMID: 37075118 PMCID: PMC10115410 DOI: 10.1126/sciadv.adf6537] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Approximately 80 million people globally are affected by glaucoma, with a projected increase to over 110 million by 2040. Substantial issues surrounding patient compliance remain with topical eye drops, and up to 10% of patients become treatment resistant, putting them at risk of permanent vision loss. The major risk factor for glaucoma is elevated intraocular pressure, which is regulated by the balance between the secretion of aqueous humor and the resistance to its flow across the conventional outflow pathway. Here, we show that adeno-associated virus 9 (AAV9)-mediated expression of matrix metalloproteinase-3 (MMP-3) can increase outflow in two murine models of glaucoma and in nonhuman primates. We show that long-term AAV9 transduction of the corneal endothelium in the nonhuman primate is safe and well tolerated. Last, MMP-3 increases outflow in donor human eyes. Collectively, our data suggest that glaucoma can be readily treated with gene therapy-based methods, paving the way for deployment in clinical trials.
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Affiliation(s)
| | - Conor Delaney
- Smurfit Institute of Genetics, Trinity College Dublin, Dublin 2, Ireland
| | | | | | - Martin Schicht
- Institute of Functional and Clinical Anatomy, University of Erlangen-Nuremburg, Erlangen, Germany
| | - Elke Lütjen-Drecoll
- Institute of Functional and Clinical Anatomy, University of Erlangen-Nuremburg, Erlangen, Germany
| | - Natalie Hudson
- Smurfit Institute of Genetics, Trinity College Dublin, Dublin 2, Ireland
| | | | - Peter Humphries
- Smurfit Institute of Genetics, Trinity College Dublin, Dublin 2, Ireland
| | | | | | | | | | - Matthew Campbell
- Smurfit Institute of Genetics, Trinity College Dublin, Dublin 2, Ireland
- Corresponding author.
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5
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Liu GW, Guzman EB, Menon N, Langer RS. Lipid Nanoparticles for Nucleic Acid Delivery to Endothelial Cells. Pharm Res 2023; 40:3-25. [PMID: 36735106 PMCID: PMC9897626 DOI: 10.1007/s11095-023-03471-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 01/12/2023] [Indexed: 02/04/2023]
Abstract
Endothelial cells play critical roles in circulatory homeostasis and are also the gateway to the major organs of the body. Dysfunction, injury, and gene expression profiles of these cells can cause, or are caused by, prevalent chronic diseases such as diabetes, cardiovascular disease, and cancer. Modulation of gene expression within endothelial cells could therefore be therapeutically strategic in treating longstanding disease challenges. Lipid nanoparticles (LNP) have emerged as potent, scalable, and tunable carrier systems for delivering nucleic acids, making them attractive vehicles for gene delivery to endothelial cells. Here, we discuss the functions of endothelial cells and highlight some receptors that are upregulated during health and disease. Examples and applications of DNA, mRNA, circRNA, saRNA, siRNA, shRNA, miRNA, and ASO delivery to endothelial cells and their targets are reviewed, as well as LNP composition and morphology, formulation strategies, target proteins, and biomechanical factors that modulate endothelial cell targeting. Finally, we discuss FDA-approved LNPs as well as LNPs that have been tested in clinical trials and their challenges, and provide some perspectives as to how to surmount those challenges.
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Affiliation(s)
- Gary W Liu
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
| | - Edward B Guzman
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
- Department of Biology, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
- School of Engineering and Applied Sciences, Harvard University, Cambridge, MA, 02138, USA
| | - Nandita Menon
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
- Strand Therapeutics, MA, 02215, Boston, USA
| | - Robert S Langer
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA.
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6
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Song Y, Zhang Y, Li F, Zhang Y, Lin F, Lv A, Li X, Lu P, Xiao M, Zhang H, Yan X, Zhu X, Song W, Zhao X, Gao X, Hu K, Liang X, Zhang X, Wang Z, Shi J, Zhu Y, Zhang Y, Fan S, Tang G, Lu L, Xie L, Yuan H, Zhou M, Chen W, Tang L, Lam DSC, Weinreb RN, Zhang X. One-Year Results of a Multicenter Study: Intraocular Pressure-Lowering Effect of Combined Phacoemulsification, Goniosynechialysis, and Goniotomy for Cases of Advanced Primary Angle-Closure Glaucoma With Cataract. Asia Pac J Ophthalmol (Phila) 2022; 11:529-535. [PMID: 36417677 DOI: 10.1097/apo.0000000000000579] [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: 06/01/2022] [Accepted: 09/28/2022] [Indexed: 11/24/2022] Open
Abstract
PURPOSE To evaluate the intraocular pressure (IOP)-lowering effect of the combination of phacoemulsification with intraocular lens implantation (PEI), goniosynechialysis (GSL), and goniotomy (GT) in eyes of advanced primary angle-closure glaucoma (PACG) with cataract. DESIGN Multicenter observational study. METHODS We enrolled 83 eyes of 83 patients with advanced PACG who received combined PEI+GSL+GT at 8 ophthalmic institutes. Each patient was assessed before treatment and at 1, 7 days, 1, 3, 6, and 12 months postsurgery. The criteria for complete success were IOP within 6 to 18 mm Hg and at least 20% of reduction in IOP from baseline without ocular hypotensive medications or reoperation. The definition of qualified success was similar to that of complete success, except for the need for ocular hypotensive medications. The potential prognostic factors for surgical success were investigated using a multivariate logistic model. RESULTS All participants completed 1 year of follow-up. Complete and qualified success were achieved in 74 (89.1%) and 79 (95.2%) of 83 eyes, respectively. The mean preoperative and postsurgical IOPs were 27.4±7.3 and 14.2±2.6 mm Hg, respectively. Participants used an average of 2.0 and 0.3 types of ocular hypotensive medications before and after surgery, respectively. The chief complications included hyphema (n=9), IOP spike (n=9), and corneal edema (n=8). None of the eyes required reoperation or developed vision-threatening complications. Multivariate analysis showed that older age was associated with a higher probability of complete success (odds ratio=1.13; 95% CI: 1.02-1.25; P=0.020). CONCLUSIONS The 1-year results of combination of PEI+GSL+GT in treating advanced PACG cases with cataract appear to be safe and effective. Further large-scale multination and multicenter studies are warranted.
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Affiliation(s)
- Yunhe Song
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, Guangdong Province, China
| | - Yi Zhang
- Department of Ophthalmology, West China Hospital of Sichuan University, Chengdu, Sichuan Province, China
| | - Fei Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, Guangdong Province, China
| | - Yingzhe Zhang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, Guangdong Province, China
| | - Fengbin Lin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, Guangdong Province, China
| | - Aiguo Lv
- Handan City Eye Hospital (The Third Hospital of Handan), Handan, Hebei Province, China
| | - Xiaoyan Li
- Handan City Eye Hospital (The Third Hospital of Handan), Handan, Hebei Province, China
| | - Ping Lu
- Handan City Eye Hospital (The Third Hospital of Handan), Handan, Hebei Province, China
| | - Meichun Xiao
- Department of Ophthalmology, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China
| | - Hengli Zhang
- Department of Ophthalmology, Shijiazhuang People's Hospital, Shijiazhuang, Hebei Province, China
| | - Xiaowei Yan
- Department of Ophthalmology, Shijiazhuang People's Hospital, Shijiazhuang, Hebei Province, China
| | - Xiaomin Zhu
- Department of Ophthalmology, The Third Affiliated Hospital of Chongqing Medical University, Chongqing, Sichuan Province, China
| | - Wulian Song
- Department of Ophthalmology, The 2nd Affiliated Hospital, Harbin Medical University, Harbin, Heilongjiang Province, China
| | - Xiaohuan Zhao
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Xinbo Gao
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, Guangdong Province, China
| | - Kun Hu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, Guangdong Province, China
| | - Xiaohong Liang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, Guangdong Province, China
| | - Xi Zhang
- Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou Province, China
| | - Zhenyu Wang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, Guangdong Province, China
| | - Jiguang Shi
- Enshi Huiyi Eye Hospital, Enshi, Hubei Province, China
| | - Yunyun Zhu
- The eighth affiliated hospital, Sun Yat-sen University, Shenzhen, China
| | - Yu Zhang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, Guangdong Province, China
| | - Sujie Fan
- Handan City Eye Hospital (The Third Hospital of Handan), Handan, Hebei Province, China
| | - Guangxian Tang
- Department of Ophthalmology, Shijiazhuang People's Hospital, Shijiazhuang, Hebei Province, China
| | - Lan Lu
- Department of Ophthalmology, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China
| | - Lin Xie
- Department of Ophthalmology, The Third Affiliated Hospital of Chongqing Medical University, Chongqing, Sichuan Province, China
| | - Huiping Yuan
- Department of Ophthalmology, The 2nd Affiliated Hospital, Harbin Medical University, Harbin, Heilongjiang Province, China
| | - Minwen Zhou
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Weirong Chen
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, Guangdong Province, China
| | - Li Tang
- Department of Ophthalmology, West China Hospital of Sichuan University, Chengdu, Sichuan Province, China
| | - Dennis S C Lam
- The C-MER International Eye Research Center of The Chinese University of Hong Kong (Shenzhen), Shenzhen, China
- The C-MER (Shenzhen) Dennis Lam Eye Hospital, Shenzhen, China
| | - Robert N Weinreb
- Hamilton Glaucoma Center, Viterbi Family Department of Ophthalmology, and Shiley Eye Institute, University of California San Diego, La Jolla, CA, US
| | - Xiulan Zhang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, Guangdong Province, China
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Soundararajan A, Wang T, Ghag SA, Kang MH, Pattabiraman PP. Novel insight into the role of clusterin on intraocular pressure regulation by modifying actin polymerization and extracellular matrix remodeling in the trabecular meshwork. J Cell Physiol 2022; 237:3012-3029. [PMID: 35567755 PMCID: PMC9283260 DOI: 10.1002/jcp.30769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2021] [Revised: 04/03/2022] [Accepted: 04/20/2022] [Indexed: 11/09/2022]
Abstract
This study provides comprehensive mechanistic evidence for the role of clusterin, a stress-response secretory chaperone protein, in the modulation of intraocular pressure (IOP) by regulating the trabecular meshwork (TM) actin cytoskeleton and the extracellular matrix (ECM). The pathological stressors on TM known to elevate IOP significantly lowered clusterin protein levels indicating stress-related clusterin function loss. Small interfering RNA-mediated clusterin loss in human TM cells in vitro induced actin polymerization and stabilization via protein kinase D1, serine/threonine-protein kinase N2 (PRK2), and LIM kinase 1 (LIMK1), and the recruitment and activation of adhesome proteins including paxillin, vinculin, and integrin αV and β5. A complete loss of clusterin as seen in clusterin knockout mice (Clu-/- ) led to significant IOP elevation at postnatal Day 70. Contrarily, constitutive clusterin expression using adenovirus (AdCLU) in HTM cells resulted in the loss of actin polymerization via decreased PRK2, and LIMK1 and negative regulation of integrin αV and β5. Furthermore, we found that AdCLU treatment in HTM cells significantly decreased the ECM protein expression and distribution by significantly increasing matrix metalloprotease 2 (MMP2) activity and lowering the levels of pro-fibrotic proteins such as transforming growth factor-β2 (TGFβ2), thrombospondin-1 (TSP-1), and plasminogen activator inhibitor-1 (PAI-1). Finally, we found that HTM cells supplemented with recombinant human clusterin attenuated the pro-fibrotic effects of TGFβ2. For the first time this study demonstrates the importance of clusterin in the regulation of TM actin cytoskeleton - ECM interactions and the maintenance of IOP, thus making clusterin an interesting target to reverse elevated IOP.
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Affiliation(s)
- Avinash Soundararajan
- Department of Ophthalmology, Glick Eye InstituteIndiana University School of MedicineIndianapolisIndianaUSA
| | - Ting Wang
- Department of Ophthalmology, Glick Eye InstituteIndiana University School of MedicineIndianapolisIndianaUSA
- Stark Neuroscience Research InstituteIndiana University Purdue University IndianapolisIndianapolisIndianaUSA
| | - Sachin A. Ghag
- Department of Ophthalmology, Glick Eye InstituteIndiana University School of MedicineIndianapolisIndianaUSA
| | - Min H. Kang
- Department of Ophthalmology and Visual Sciences, University Hospitals Eye InstituteCase Western Reserve University School of MedicineClevelandOhioUSA
| | - Padmanabhan P. Pattabiraman
- Department of Ophthalmology, Glick Eye InstituteIndiana University School of MedicineIndianapolisIndianaUSA
- Stark Neuroscience Research InstituteIndiana University Purdue University IndianapolisIndianapolisIndianaUSA
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Sun D, Zhan Z, Zeng R, Liu X, Wang B, Yang F, Huang S, Li Y, Yang Z, Su Y, Lan Y. Long-term and potent IOP-lowering effect of IκBα-siRNA in a nonhuman primate model of chronic ocular hypertension. iScience 2022; 25:104149. [PMID: 35445186 PMCID: PMC9014385 DOI: 10.1016/j.isci.2022.104149] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 02/28/2022] [Accepted: 03/20/2022] [Indexed: 11/26/2022] Open
Abstract
Glaucoma is one of the most common causes of irreversible blindness. It is acknowledged that lowering intraocular pressure (IOP) is the effective treatment to slow glaucoma disease progression. The main obstacle of existing drugs is that the effect of reducing IOP does not last long. Degradation of IκB stimulates the transcription of NF-κB, which could upregulate the expression of matrix metalloproteinases (MMPs). Whether a IκB-targeted gene therapy works in glaucoma is unclear. Here, we established a chronic ocular hypertension (COHT) model in rhesus monkey by laser photocoagulation and verified that intracameral delivery of IκBα-siRNA showed long-lasting and potent effects of reducing IOP without obvious inflammation in monkeys with COHT. We also verified that IκBα-siRNA could increase the expressions of MMP2 and MMP9 by knocking down IκBα in vitro and in vivo. Our results in nonhuman primates indicated that IκBα-siRNA may become a promising therapeutic approach for the treatment of glaucoma. Knocking down IκBα could upregulate the expression of MMP2 and MMP9 in MCM and MTM LP could induce COHT model in rhesus monkeys successfully IκBα-siRNA has a long-term and potent IOP-lowering effect in LP-induced monkeys with COHT
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Affiliation(s)
- Difang Sun
- Department of Ophthalmology, Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Zongyi Zhan
- Department of Ophthalmology, Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Rui Zeng
- Department of Ophthalmology, Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Xiaolin Liu
- Guangdong Provincial Key Laboratory of Laboratory Animals, Guangdong Laboratory Animals Monitoring Institute, Guangdong Laboratory Animals Monitoring Institute, Guangzhou, China
| | - Bin Wang
- Department of Sports Medicine, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Fan Yang
- Department of Ophthalmology, Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Sa Huang
- Guangdong Provincial Key Laboratory of Laboratory Animals, Guangdong Laboratory Animals Monitoring Institute, Guangdong Laboratory Animals Monitoring Institute, Guangzhou, China
| | - Yunfeng Li
- Guangdong Provincial Key Laboratory of Laboratory Animals, Guangdong Laboratory Animals Monitoring Institute, Guangdong Laboratory Animals Monitoring Institute, Guangzhou, China
| | - Zhenlan Yang
- Department of Ophthalmology, Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Yuanyuan Su
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Medical Research Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Yuqing Lan
- Department of Ophthalmology, Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
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Distribution of Gold Nanoparticles in the Anterior Chamber of the Eye after Intracameral Injection for Glaucoma Therapy. Pharmaceutics 2021; 13:pharmaceutics13060901. [PMID: 34204364 PMCID: PMC8235414 DOI: 10.3390/pharmaceutics13060901] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 06/14/2021] [Accepted: 06/15/2021] [Indexed: 12/20/2022] Open
Abstract
In glaucoma therapy, nanoparticles (NPs) are a favorable tool for delivering drugs to the outflow tissues of the anterior chamber of the eye where disease development and progression take place. In this context, a prerequisite is an efficient enrichment of NPs in the trabecular meshwork with minimal accumulation in off-target tissues such as the cornea, lens, iris and ciliary body. We evaluated the optimal size for targeting the trabecular meshwork by using gold NPs of 5, 60, 80 and 120 nm with a bare surface (AuNPs) or coated with hyaluronic acid (HA-AuNPs). NPs were compared regarding their colloidal stability, distribution in the anterior chamber of the eye ex vivo and cellular uptake in vitro. HA-AuNPs demonstrated an exceptional colloidal stability. Even after application into porcine eyes ex vivo, the HA coating prevented an aggregation of NPs inside the trabecular meshwork. NPs with a diameter of 120 nm exhibited the highest volume-based accumulation in the trabecular meshwork. Off-target tissues in the anterior chamber demonstrated an exceptionally low gold content. Our findings are particularly important for NPs with encapsulated anti-glaucoma drugs because a higher particle volume would be accompanied by a higher drug payload.
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