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Beros AL, Sluyter JD, Hughes AD, Hametner B, Wassertheurer S, Scragg RKR. Arterial Stiffness and Incident Glaucoma: A Large Population-Based Cohort Study. Am J Ophthalmol 2024; 266:68-76. [PMID: 38754800 DOI: 10.1016/j.ajo.2024.05.015] [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: 02/04/2024] [Revised: 04/11/2024] [Accepted: 05/13/2024] [Indexed: 05/18/2024]
Abstract
PURPOSE To investigate whether arterial stiffness, assessed oscillometrically, is associated with incident glaucoma in the Vitamin D Assessment (ViDA) Study cohort, aged 50 to 84 years. DESIGN Prospective, population-based cohort study. METHODS Arterial stiffness was assessed in 4,713 participants without known glaucoma (mean ± SD age = 66 ± 8 years) from 5 April 2011 to 6 November 2012 by way of aortic PWV (aPWV), estimated carotid-femoral PWV (ePWV) and aortic PP (aPP). Incident glaucoma was identified through linkage to national prescription and hospital discharge registers. Relative risks of glaucoma for each arterial stiffness measure were estimated by Cox proportional hazards regression, over the continuum of values and by quartiles. RESULTS During a mean ± SD follow-up of 10.5±0.4 years, 301 participants developed glaucoma. Arterial stiffness, as measured by aPWV (Hazard ratio (HR) per SD increase, 1.36, 95% CI 1.14-1.62) and ePWV (HR per SD increase, 1.40, 95% CI 1.14-1.71) but not aPP (HR per SD increase, 1.06, 95% CI 0.92-1.23) was associated with incident glaucoma. When arterial stiffness was analyzed as a categorical variable, the highest quartiles of aPWV (HR, 2.62, 95% CI 1.52-4.52; Ptrend = .007), ePWV (HR, 2.42, 95%CI 1.37-4.27; Ptrend = .03), and aPP (HR, 1.68, 95%CI 1.10-2.5; Ptrend = .02) were associated with the development of glaucoma. CONCLUSIONS Arterial stiffness measured with a simple oscillometric device predicted the development of glaucoma and could potentially be used in clinical practice to help identify people at risk of this condition. It may also present a new therapeutic research avenue, including in respect of systemic antihypertensives.
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Affiliation(s)
- Angela L Beros
- School of Population Health (A.L.B., J.D.S., R.K.R.S.), University of Auckland, Auckland, New Zealand
| | - John D Sluyter
- School of Population Health (A.L.B., J.D.S., R.K.R.S.), University of Auckland, Auckland, New Zealand
| | - Alun D Hughes
- Institute of Cardiovascular Sciences (A.D.H.), University College London, London, United Kingdom
| | - Bernhard Hametner
- Center for Health & Bioresources (B.H., S.W.), AIT Austrian Institute of Technology, Vienna, Austria
| | - Siegfried Wassertheurer
- Center for Health & Bioresources (B.H., S.W.), AIT Austrian Institute of Technology, Vienna, Austria
| | - Robert K R Scragg
- School of Population Health (A.L.B., J.D.S., R.K.R.S.), University of Auckland, Auckland, New Zealand.
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Bengtsson B, Heijl A, Aspberg J, Jóhannesson G, Andersson-Geimer S, Lindén C. The Glaucoma Intensive Treatment Study (GITS): A Randomized Controlled Trial Comparing Intensive and Standard Treatment on 5 Years Visual Field Development. Am J Ophthalmol 2024; 266:274-288. [PMID: 38909742 DOI: 10.1016/j.ajo.2024.06.017] [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: 11/10/2023] [Revised: 06/11/2024] [Accepted: 06/11/2024] [Indexed: 06/25/2024]
Abstract
PURPOSE To assess the effect of an intensive initial intraocular pressure (IOP)-lowering treatment strategy on the progression of visual field damage. DESIGN A randomized, controlled, open-label, 2-center clinical trial. METHODS A total of 242 patients with newly detected early or moderate untreated open-angle glaucoma were enrolled at 2 university hospitals in Sweden. Participants were randomly allocated (1:1) to either initial treatment with intensive IOP-lowering medications followed by 360° laser trabeculoplasty (LTP), or to traditional mono-therapy, which was increased when deemed necessary. The primary study outcome of interest was the predicted remaining visual field, as measured by the visual field index (VFI) at projected end of life. RESULTS The median untreated IOP was 24 mm Hg in both treatment groups. During follow-up, median and mode IOP were 17 mm Hg in the mono- and 14 mm Hg in the multi-treatment group. In the mono-treatment group, the median VFI at projected end of life was 79.3% and in the multi-treatment group 87.1% (P = .15). The annual rate of progression of visual field damage was faster in mono-treatment than in multi-treatment participants; median losses per year were 0.65 and 0.25 percentage units, respectively (P = .09). Progression events occurred in 21% of the mono- and in 11% of the multi-treatment participants (P = .03). Adverse events, mostly mild, were reported in 25% of the mono- and in 36% of the multi-treatment participants. Differences in visual field outcomes between treatment groups were more pronounced in participants having higher baseline IOP, defined by median split of untreated IOP values. CONCLUSIONS In the overall analysis, the visual field outcomes were not overwhelmingly better in the multi-treatment group, but post hoc analysis showed definite benefit in patients with higher untreated IOP. Based on the results of this study, initial intensive treatment may be considered in glaucoma patients with high untreated IOP at diagnosis, although we found no evidence that multi-therapy should be given routinely to all glaucoma patients.
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Affiliation(s)
- Boel Bengtsson
- From the Department of Clinical Sciences in Malmö, Ophthalmology (B.B., A.H., J.A., S.A.-G.), Lund University, Malmö, Sweden.
| | - Anders Heijl
- From the Department of Clinical Sciences in Malmö, Ophthalmology (B.B., A.H., J.A., S.A.-G.), Lund University, Malmö, Sweden; Department of Ophthalmology (A.H., J.A., S.A.-G.), Skåne University Hospital, Malmö/Lund, Sweden
| | - Johan Aspberg
- From the Department of Clinical Sciences in Malmö, Ophthalmology (B.B., A.H., J.A., S.A.-G.), Lund University, Malmö, Sweden; Department of Ophthalmology (A.H., J.A., S.A.-G.), Skåne University Hospital, Malmö/Lund, Sweden
| | - Gauti Jóhannesson
- Department of Clinical Sciences (G.J., C.L.), Umeå University, Umeå, Sweden; Wallenberg Center for Molecular Medicine (G.J.), Umeå University, Umeå, Sweden; Department of Ophthalmology (G.J.), University of Iceland, Reykjavik, Iceland
| | - Sabina Andersson-Geimer
- From the Department of Clinical Sciences in Malmö, Ophthalmology (B.B., A.H., J.A., S.A.-G.), Lund University, Malmö, Sweden; Department of Ophthalmology (A.H., J.A., S.A.-G.), Skåne University Hospital, Malmö/Lund, Sweden
| | - Christina Lindén
- Department of Clinical Sciences (G.J., C.L.), Umeå University, Umeå, Sweden
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3
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Shao Y, Hu B, Liu X, Ni Z, Shu Y, Zhang X, Shen J, Liang L, Zhou L, Liu J, Li X, Zhang J, Ma L, Di Z, Mei Y, Li R, Bi Y, Song E. Multi-functional, conformal systems with ultrathin crystalline-silicon-based bioelectronics for characterization of intraocular pressure and ocular surface temperature. Biosens Bioelectron 2024; 267:116786. [PMID: 39326320 DOI: 10.1016/j.bios.2024.116786] [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: 03/27/2024] [Revised: 05/28/2024] [Accepted: 09/15/2024] [Indexed: 09/28/2024]
Abstract
Technologies that established in vivo evaluations of soft-tissue biomechanics and temperature are essential to biological research and clinical diagnostics, particularly for a wide range of eye-related diseases such as glaucoma. Of importance are advanced bioelectronic devices for high-precise monitoring of intraocular pressure (IOP) and various ocular temperatures, as clinically proven uses for glaucoma diagnosis. Existing characterization methods are temporary, single point, and lack microscale resolution, failing to measure continuous IOP fluctuation across the long-term period. Here, this work presents a multi-functional smart contact lens, capable of rapidly capturing IOP fluctuation and ocular surface temperature (OST) for assistance for clinical use. The microscale device design is programmable and determined by finite element analysis simulation, with detailed experiments of ex vivo porcine eyeballs. Such compact bioelectronics can provide high-precise measurement with sensitivity of 0.03% mmHg-1 and 1.2 Ω °C-1 in the range of Δ2∼50 mmHg and 30-50 °C, respectively. In vivo tests of bio-integration with a living rabbit can evaluate real-time IOP fluctuation and OST, as of biocompatibility assessments verified through cellular and animal experiments. The resultant bioelectronic devices for continuous precise characterization of living eyeballs can offer broad utility for hospital diagnosis of a wide range of eye-related disorders.
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Affiliation(s)
- Yuting Shao
- Department of Ophthalmology, Tongji Eye Institute, Tongji Hospital, School of Medicine, Tongji University, Shanghai, 200065, People's Republic of China; Shanghai Frontiers Science Research Base of Intelligent Optoelectronics and Perception, Institute of Optoelectronics, Fudan University, Shanghai, 200438, People's Republic of China; State Key Laboratory of Integrated Chips and Systems, Frontier Institute of Chip and System, Fudan University, Shanghai, 200438, People's Republic of China
| | - Bofan Hu
- Department of Materials Science & State Key Laboratory of Molecular Engineering of Polymers, Fudan University, Shanghai, 200438, People's Republic of China
| | - Xin Liu
- Department of Ophthalmology, Guizhou Provincial People's Hospital, Guiyang, 550000, People's Republic of China
| | - Zhuofan Ni
- School of Mechanics and Aerospace Engineering, State Key Laboratory of Structural Analysis, Optimization and CAE Software for Industrial Equipment, and International Research Center for Computational Mechanics, Dalian University of Technology, Dalian, 116024, People's Republic of China
| | - Yiyang Shu
- Department of Ophthalmology, Tongji Eye Institute, Tongji Hospital, School of Medicine, Tongji University, Shanghai, 200065, People's Republic of China
| | - Xiruo Zhang
- Department of Ophthalmology, Tongji Eye Institute, Tongji Hospital, School of Medicine, Tongji University, Shanghai, 200065, People's Republic of China
| | - Jiaqi Shen
- Department of Ophthalmology, Tongji Eye Institute, Tongji Hospital, School of Medicine, Tongji University, Shanghai, 200065, People's Republic of China
| | - Li Liang
- School of Mechanics and Aerospace Engineering, State Key Laboratory of Structural Analysis, Optimization and CAE Software for Industrial Equipment, and International Research Center for Computational Mechanics, Dalian University of Technology, Dalian, 116024, People's Republic of China
| | - Lianjie Zhou
- Shanghai Frontiers Science Research Base of Intelligent Optoelectronics and Perception, Institute of Optoelectronics, Fudan University, Shanghai, 200438, People's Republic of China
| | - Junhan Liu
- Department of Materials Science & State Key Laboratory of Molecular Engineering of Polymers, Fudan University, Shanghai, 200438, People's Republic of China
| | - Xiao Li
- School of Biomedical Sciences, Heart and Vascular Institute and Li Ka Shing Institute of Health Science, Faculty of Medicine, The Chinese University of Hong Kong, People's Republic of China
| | - Juan Zhang
- Department of Ophthalmology, Tongji Eye Institute, Tongji Hospital, School of Medicine, Tongji University, Shanghai, 200065, People's Republic of China
| | - Lichao Ma
- Shanghai Frontiers Science Research Base of Intelligent Optoelectronics and Perception, Institute of Optoelectronics, Fudan University, Shanghai, 200438, People's Republic of China
| | - Zengfeng Di
- Shanghai Institute of Microsystem and Information Technology (CAS), Shanghai, 201800, People's Republic of China
| | - Yongfeng Mei
- Shanghai Frontiers Science Research Base of Intelligent Optoelectronics and Perception, Institute of Optoelectronics, Fudan University, Shanghai, 200438, People's Republic of China; Department of Materials Science & State Key Laboratory of Molecular Engineering of Polymers, Fudan University, Shanghai, 200438, People's Republic of China
| | - Rui Li
- School of Mechanics and Aerospace Engineering, State Key Laboratory of Structural Analysis, Optimization and CAE Software for Industrial Equipment, and International Research Center for Computational Mechanics, Dalian University of Technology, Dalian, 116024, People's Republic of China.
| | - Yanlong Bi
- Department of Ophthalmology, Tongji Eye Institute, Tongji Hospital, School of Medicine, Tongji University, Shanghai, 200065, People's Republic of China.
| | - Enming Song
- Department of Ophthalmology, Tongji Eye Institute, Tongji Hospital, School of Medicine, Tongji University, Shanghai, 200065, People's Republic of China; Shanghai Frontiers Science Research Base of Intelligent Optoelectronics and Perception, Institute of Optoelectronics, Fudan University, Shanghai, 200438, People's Republic of China; Department of Materials Science & State Key Laboratory of Molecular Engineering of Polymers, Fudan University, Shanghai, 200438, People's Republic of China; State Key Laboratory of Integrated Chips and Systems, Frontier Institute of Chip and System, Fudan University, Shanghai, 200438, People's Republic of China.
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Wang Y, Guo Y, Zhang Y, Huang S, Zhong Y. Differences and Similarities Between Primary Open Angle Glaucoma and Primary Angle-Closure Glaucoma. Eye Brain 2024; 16:39-54. [PMID: 39309574 PMCID: PMC11416111 DOI: 10.2147/eb.s472920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Accepted: 08/29/2024] [Indexed: 09/25/2024] Open
Abstract
Glaucoma is the leading cause of irreversible blindness worldwide. It is an ocular disease characterized by an increase in intraocular pressure or, in some cases, normal intraocular pressure, which leads to optic nerve damage and progressive constriction of the visual field (VF). Primary Open-Angle Glaucoma (POAG) and Primary Angle-Closure Glaucoma (PACG) represent the predominant forms of glaucoma. Numerous hypotheses have been posited to elucidate the pathogenic mechanisms underlying these conditions. There is an emerging understanding of the distinct pathological processes that differentiate the various types of glaucoma. While some similarities in the mechanisms between PACG and POAG have been suggested, evidence indicates that there are also significant differences between the two. This review synthesizes the similarities and differences in the etiology of optic neuropathy caused by POAG and PACG, considering their respective pathophysiological mechanisms, the morphology of the optic disc and surrounding tissues, genetic characteristics, optical coherence tomography angiography, optical coherence tomography, and structural and functional features from VF examinations. These characteristics may contribute to a deeper comprehension of the underlying pathogenesis of glaucoma and enhance the management of different types of this ocular condition.
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Affiliation(s)
- Yiwei Wang
- Author Affiliations Department of Ophthalmology, Ruijin Hospital Affiliated Medical School, Shanghai Jiao tong University, Shanghai, 200025, People’s Republic of China
| | - Yanzhi Guo
- Author Affiliations Department of Ophthalmology, Ruijin Hospital Affiliated Medical School, Shanghai Jiao tong University, Shanghai, 200025, People’s Republic of China
| | - Yang Zhang
- Author Affiliations Department of Ophthalmology, Ruijin Hospital Affiliated Medical School, Shanghai Jiao tong University, Shanghai, 200025, People’s Republic of China
| | - Shouyue Huang
- Author Affiliations Department of Ophthalmology, Ruijin Hospital Affiliated Medical School, Shanghai Jiao tong University, Shanghai, 200025, People’s Republic of China
| | - Yisheng Zhong
- Author Affiliations Department of Ophthalmology, Ruijin Hospital Affiliated Medical School, Shanghai Jiao tong University, Shanghai, 200025, People’s Republic of China
- Author affiliations Department of Ophthalmology, Wuxi Branch of Ruijin Hospital Affiliated Medical School, Shanghai Jiao tong University, Wuxi, People’s Republic of China
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Varshney T, Maddu SV, Satpute K, Angmo D. In vivo angle dysgenesis in PHACE syndrome with developmental glaucoma. BMJ Case Rep 2024; 17:e255434. [PMID: 39214587 DOI: 10.1136/bcr-2023-255434] [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] [Indexed: 09/04/2024] Open
Abstract
A girl in middle childhood presented with glaucoma in her right eye along with segmental haemangiomas on the right side of the face and neck. Magnetic resonance angiography of the brain showed hypoplasia of the right internal carotid artery, leading to the diagnosis of posterior fossa malformations, haemangioma, arterial anomalies, cardiac defects and eye abnormalities (PHACE) syndrome. High-definition anterior segment ocular coherence tomography (AS-OCT) of the right eye showed an absence of Schlemm's canal and a hyperreflective membrane over the trabecular meshwork. The presence of this angle dysgenesis on AS-OCT, a novel finding in this disease, explained the elevated intraocular pressure in the right eye. The embryological basis for the development of angle dysgenesis might help better understand the pathogenesis of PHACE syndrome.
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Affiliation(s)
- Toshit Varshney
- Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, Delhi, Delhi, India
| | - Sai Vineeth Maddu
- Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, Delhi, Delhi, India
| | - Kanchangouri Satpute
- Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, Delhi, Delhi, India
| | - Dewang Angmo
- Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, Delhi, Delhi, India
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6
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Hallaj S, Khawaja AP, Rodrigues IAS, Boland MV, Brown EN, Chen A, Stagg BC, Stein JD, Sun CQ, Mahe-Cook AL, Swaminathan SS, Wang SY, Xu BY, Weinreb RN, Baxter SL. Gap Analysis of Glaucoma Examination Concept Representations within Standard Systemized Nomenclature of Medicine - Clinical Terms. Ophthalmol Glaucoma 2024:S2589-4196(24)00140-6. [PMID: 39147325 DOI: 10.1016/j.ogla.2024.08.001] [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: 03/06/2024] [Revised: 08/01/2024] [Accepted: 08/02/2024] [Indexed: 08/17/2024]
Abstract
OBJECTIVE/PURPOSE Standardization of eye care data is important for clinical interoperability and research. We aimed to address gaps in the representations of glaucoma examination concepts within Systemized Nomenclature of Medicine - Clinical Terms (SNOMED-CT), the preferred terminology of the American Academy of Ophthalmology. DESIGN Study of data elements. METHODS Structured eye examination data fields from 2 electronic health records (EHR) systems (Epic Systems and Medisoft) were compared against existing SNOMED-CT codes for concepts representing glaucoma examination findings. Glaucoma specialists from multiple institutions were surveyed to identify high-priority gaps in representation, which were discussed among the SNOMED International Eye Care Clinical Reference Group. Proposals for new codes to address the gaps were formulated and submitted for inclusion in SNOMED-CT. MAIN OUTCOME MEASURES Gaps in SNOMED-CT glaucoma examination concept representations. RESULTS We identified several gaps in SNOMED-CT regarding glaucoma examination concepts. A survey of glaucoma specialists identified high-priority data elements within the categories of tonometry and gonioscopy. For tonometry, there was consensus that we need to define new codes related to maximum intraocular pressure (IOP) and target IOP and delineate all methods of measuring IOP. These new codes were proposed and successfully added to SNOMED-CT for future use. Regarding gonioscopy, the current terminology did not include the ability to denote the gonioscopic grading system used (e.g., Shaffer or Spaeth), degree of angle pigmentation, iris configuration (except for plateau iris), and iris approach. There was also no ability to specify eye laterality or angle quadrant for gonioscopic findings. We proposed a framework for representing gonioscopic findings as observable entities in SNOMED-CT. CONCLUSION There are existing gaps in the standardized representation of findings related to tonometry and gonioscopy within SNOMED-CT. These are important areas for evaluating clinical outcomes and enabling secondary use of EHR data for glaucoma research. This international multi-institutional collaborative process enabled identification of gaps, prioritization, and development of data standards to address these gaps. Addressing these gaps and augmenting SNOMED-CT coverage of glaucoma examination findings could enhance clinical documentation and future research efforts related to glaucoma. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- Shahin Hallaj
- Division of Ophthalmology Informatics and Data Science, Viterbi Family Department of Ophthalmology, Shiley Eye Institute, University of California, San Diego, La Jolla, California; Division of Biomedical Informatics, Department of Medicine, University of California San Diego, La Jolla, California; Hamilton Glaucoma Center, Viterbi Family Department of Ophthalmology, Shiley Eye Institute, University of California, San Diego, La Jolla, California
| | - Anthony P Khawaja
- National Institute for Health and Care Research Biomedical Research Centre, Moorfields Eye Hospital National Health Service Foundation Trust and University College London Institute of Ophthalmology, London, UK
| | - Ian A S Rodrigues
- Department of Ophthalmology, St Thomas' Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Michael V Boland
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts
| | - Eric N Brown
- Department of Ophthalmology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Aiyin Chen
- Casey Eye Institute, Oregon Health & Science University, Portland, Oregon
| | - Brian C Stagg
- Department of Ophthalmology and Visual Sciences, John Moran Eye Center, University of Utah, Salt Lake City, Utah; Department of Population Health Sciences, University of Utah, Salt Lake City, Utah
| | - Joshua D Stein
- Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor, Michigan
| | - Catherine Q Sun
- Department of Ophthalmology (C.Q.S.), University of California, San Francisco, California; F.I. Proctor Foundation (C.Q.S.), University of California, San Francisco, California
| | | | - Swarup S Swaminathan
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Sophia Y Wang
- Byers Eye Institute, Department of Ophthalmology, Stanford University, Palo Alto, California
| | - Benjamin Y Xu
- Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine at the University of Southern California, Los Angeles, California
| | - Robert N Weinreb
- Hamilton Glaucoma Center, Viterbi Family Department of Ophthalmology, Shiley Eye Institute, University of California, San Diego, La Jolla, California
| | - Sally L Baxter
- Division of Ophthalmology Informatics and Data Science, Viterbi Family Department of Ophthalmology, Shiley Eye Institute, University of California, San Diego, La Jolla, California; Division of Biomedical Informatics, Department of Medicine, University of California San Diego, La Jolla, California; Hamilton Glaucoma Center, Viterbi Family Department of Ophthalmology, Shiley Eye Institute, University of California, San Diego, La Jolla, California.
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7
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Pang Y, Tang M, Shi M, Tian Y, Luo Y, Elze T, Pasquale LR, Zebardast N, Boland MV, Friedman DS, Shen LQ, Lokhande A, Wang M. Impact of Demographics on Regional Visual Field Loss and Deterioration in Glaucoma. Transl Vis Sci Technol 2024; 13:25. [PMID: 39136958 PMCID: PMC11323995 DOI: 10.1167/tvst.13.8.25] [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: 02/01/2024] [Accepted: 07/06/2024] [Indexed: 08/16/2024] Open
Abstract
Purpose To elucidate the impact of demographics, including gender, race, ethnicity, and preferred language, on regional visual field (VF) loss and progression in glaucoma. Methods Multivariable linear mixed regressions were performed to determine the impact of race, ethnicity, and preferred language on regional VF loss with adjustment for age and gender. Regional VF loss was defined by pointwise total deviation values and VF loss patterns quantified by an unsupervised machine learning method termed archetypal analysis. All cross-sectional and longitudinal analyses were performed both without and with adjustment for VF mean deviation, which represented overall VF loss severity. P values were corrected for multiple comparisons. Results All results mentioned had corrected P values less than 0.05. Asian and Black patients showed worse pointwise VF loss than White patients with superior hemifield more affected. Patients with a preferred language other than English demonstrated worse pointwise VF loss than patients with English as their preferred language. Longitudinal analyses revealed Black patients showed worse VF loss/year compared to White patients. Patients with a preferred language other than English demonstrated worse VF loss/year compared to patients preferring English. Conclusions Blacks and non-English speakers have more severe VF loss, with superior hemifield being more affected and faster VF worsening. Translational Relevance This study furthered our understanding of racial, ethnic, and socioeconomic disparities in glaucoma outcomes. Understanding the VF loss burden in different racial, ethnic, and socioeconomic groups may guide more effective glaucoma screening and community outreach efforts. This research could help reduce vision loss and improve quality of life in disproportionately affected populations by guiding public health efforts to promote glaucoma awareness and access to care.
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Affiliation(s)
- Yueyin Pang
- Harvard Ophthalmology AI Lab, Schepens Eye Research Institute of Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
- New York University, New York, NY, USA
| | - Melody Tang
- Harvard Ophthalmology AI Lab, Schepens Eye Research Institute of Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
- Andover High School, Andover, MA, USA
| | - Min Shi
- Harvard Ophthalmology AI Lab, Schepens Eye Research Institute of Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Yu Tian
- Harvard Ophthalmology AI Lab, Schepens Eye Research Institute of Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Yan Luo
- Harvard Ophthalmology AI Lab, Schepens Eye Research Institute of Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Tobias Elze
- Harvard Ophthalmology AI Lab, Schepens Eye Research Institute of Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Louis R. Pasquale
- Eye and Vision Research Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Nazlee Zebardast
- Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | | | | | - Lucy Q. Shen
- Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Anagha Lokhande
- Harvard Ophthalmology AI Lab, Schepens Eye Research Institute of Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Mengyu Wang
- Harvard Ophthalmology AI Lab, Schepens Eye Research Institute of Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
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8
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Sadiq DR, Mikhael EM. The Achievement of IOP Target Among a Sample of Iraqi Patients with Glaucoma: A Retrospective Study. Clin Ophthalmol 2024; 18:2107-2112. [PMID: 39051024 PMCID: PMC11268619 DOI: 10.2147/opth.s478850] [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: 05/18/2024] [Accepted: 07/02/2024] [Indexed: 07/27/2024] Open
Abstract
Background Glaucoma is a chronic progressive eye disorder. It is the primary cause of blindness. To prevent glaucomatous damage and blindness, the intra-ocular pressure (IOP) must be lowered to certain levels, this level is known as "IOP" target. Many studies conducted in developed countries have found that the majority of glaucoma patients failed to reach their target IOP. Purpose This study aimed to assess the achievement of IOP target among Iraqi patients with glaucoma and to determine the factors affecting it. Patients and Methods A single-center retrospective cohort study was conducted by inspecting the records of all patients with confirmed cases of glaucoma who were admitted to the Ibn-Al-Haitham Hospital outpatient unit from January 2020 to December 2022. To be included in the study, the patient must be newly diagnosed with glaucoma. In addition, full information on the patient's demographics, medical therapy used, and IOP at baseline and after 1 month of treatment must be available in the patient's case sheet. After considering the study inclusion criteria, the records of 760 patients were excluded, and only 100 patients were eligible. Results The included patients were mostly males, with an average age of 57.86 years. A 70% of the patients had elevated IOP in both eyes. Most patients (38%) were treated with two anti-glaucoma drugs. Only 35% of the patients achieved their targeted IOP. Regarding the factors influencing the achievement of the IOP target, all demographic data (age and gender) had a non-significant effect, while the number of prescribed drugs affected the ability of the patient to reach the IOP target. Conclusion Most of Iraqi glaucomatous patients do not achieve their IOP target. The number of prescribed eye drops can significantly affect the ability of glaucoma patients to reach their targeted IOP.
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Affiliation(s)
- Duaa Raad Sadiq
- Department of Clinical Pharmacy, University of Babylon, College of Pharmacy, Hillah, Iraq
| | - Ehab Mudher Mikhael
- Department of Clinical Pharmacy, University of Baghdad, College of Pharmacy, Baghdad, Iraq
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Spörri L, Uldry AC, Kreuzer M, Herzog EL, Zinkernagel MS, Unterlauft JD, Zysset-Burri DC. Exploring the Ocular Surface Microbiome and Tear Proteome in Glaucoma. Int J Mol Sci 2024; 25:6257. [PMID: 38892444 PMCID: PMC11172891 DOI: 10.3390/ijms25116257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2024] [Revised: 05/10/2024] [Accepted: 05/28/2024] [Indexed: 06/21/2024] Open
Abstract
Although glaucoma is a leading cause of irreversible blindness worldwide, its pathogenesis is incompletely understood, and intraocular pressure (IOP) is the only modifiable risk factor to target the disease. Several associations between the gut microbiome and glaucoma, including the IOP, have been suggested. There is growing evidence that interactions between microbes on the ocular surface, termed the ocular surface microbiome (OSM), and tear proteins, collectively called the tear proteome, may also play a role in ocular diseases such as glaucoma. This study aimed to find characteristic features of the OSM and tear proteins in patients with glaucoma. The whole-metagenome shotgun sequencing of 32 conjunctival swabs identified Actinobacteria, Firmicutes, and Proteobacteria as the dominant phyla in the cohort. The species Corynebacterium mastitidis was only found in healthy controls, and their conjunctival microbiomes may be enriched in genes of the phospholipase pathway compared to glaucoma patients. Despite these minor differences in the OSM, patients showed an enrichment of many tear proteins associated with the immune system compared to controls. In contrast to the OSM, this emphasizes the role of the proteome, with a potential involvement of immunological processes in glaucoma. These findings may contribute to the design of new therapeutic approaches targeting glaucoma and other associated diseases.
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Affiliation(s)
- Livia Spörri
- Department of Ophthalmology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland; (E.L.H.); (M.S.Z.); (J.D.U.); (D.C.Z.-B.)
| | | | - Marco Kreuzer
- Interfaculty Bioinformatics Unit and Swiss Institute of Bioinformatics, University of Bern, 3012 Bern, Switzerland;
| | - Elio L. Herzog
- Department of Ophthalmology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland; (E.L.H.); (M.S.Z.); (J.D.U.); (D.C.Z.-B.)
- Department for BioMedical Research, University of Bern, 3008 Bern, Switzerland;
- Graduate School for Cellular and Biomedical Sciences, University of Bern, 3012 Bern, Switzerland
| | - Martin S. Zinkernagel
- Department of Ophthalmology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland; (E.L.H.); (M.S.Z.); (J.D.U.); (D.C.Z.-B.)
- Department for BioMedical Research, University of Bern, 3008 Bern, Switzerland;
| | - Jan D. Unterlauft
- Department of Ophthalmology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland; (E.L.H.); (M.S.Z.); (J.D.U.); (D.C.Z.-B.)
- Department for BioMedical Research, University of Bern, 3008 Bern, Switzerland;
| | - Denise C. Zysset-Burri
- Department of Ophthalmology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland; (E.L.H.); (M.S.Z.); (J.D.U.); (D.C.Z.-B.)
- Department for BioMedical Research, University of Bern, 3008 Bern, Switzerland;
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10
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Pham AT, Bradley C, Hou K, Herbert P, Boland MV, Ramulu PY, Yohannan J. The Impact of Achieving Target Intraocular Pressure on Glaucomatous Retinal Nerve Fiber Layer Thinning in a Treated Clinical Population. Am J Ophthalmol 2024; 262:213-221. [PMID: 38035974 DOI: 10.1016/j.ajo.2023.11.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 11/16/2023] [Accepted: 11/17/2023] [Indexed: 12/02/2023]
Abstract
PURPOSE To estimate the effect of being below and above the clinician-set target intraocular pressure (IOP) on rates of glaucomatous retinal nerve fiber layer (RNFL) thinning in a treated real-world clinical population. DESIGN Retrospective cohort study. METHODS A total of 3256 eyes (1923 patients) with ≥5 reliable optical coherence tomography scans and 1 baseline visual field test were included. Linear mixed-effects modeling estimated the effects of the primary independent variables (mean target difference [measured IOP - target IOP] and mean IOP, mm Hg) on the primary dependent variable (RNFL slope, µm/y) while accounting for additional confounding variables (age, biological sex, race, baseline RNFL, baseline pachymetry, and disease severity). A spline term accounted for differential effects when above (target difference >0 mm Hg) and below (target difference ≤0 mm Hg) target pressure. RESULTS Eyes below and above target had significantly different mean RNFL slopes (-0.44 vs -0.71 µm/y, P < .001). Each 1 mm Hg increase above target had a 0.143 µm/y faster rate of RNFL thinning (P < .001). Separating by disease severity, suspect, mild, moderate, and advanced glaucoma had 0.135 (P = .002), 0.116 (P = .009), 0.203 (P = .02), and 0.65 (P = .22) µm/y faster rates of RNFL thinning per 1 mm Hg increase, respectively. CONCLUSIONS Being above the clinician-set target pressure is associated with more rapid RNFL thinning in suspect, mild, and moderate glaucoma. Faster rates of thinning were also present in advanced glaucoma, but statistical significance was limited by the lower sample size of eyes above target and the optical coherence tomography floor effect.
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Affiliation(s)
- Alex T Pham
- From the Wilmer Eye Institute, Johns Hopkins University School of Medicine (A.T.P., C.B., P.Y.R., J.Y.), Baltimore, Maryland
| | - Chris Bradley
- From the Wilmer Eye Institute, Johns Hopkins University School of Medicine (A.T.P., C.B., P.Y.R., J.Y.), Baltimore, Maryland
| | - Kaihua Hou
- Malone Center for Engineering in Healthcare, Johns Hopkins University (K.H., P.H., J.Y.), Baltimore, Maryland
| | - Patrick Herbert
- Malone Center for Engineering in Healthcare, Johns Hopkins University (K.H., P.H., J.Y.), Baltimore, Maryland
| | - Michael V Boland
- Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts (M. V. B.), USA
| | - Pradeep Y Ramulu
- From the Wilmer Eye Institute, Johns Hopkins University School of Medicine (A.T.P., C.B., P.Y.R., J.Y.), Baltimore, Maryland
| | - Jithin Yohannan
- From the Wilmer Eye Institute, Johns Hopkins University School of Medicine (A.T.P., C.B., P.Y.R., J.Y.), Baltimore, Maryland; Malone Center for Engineering in Healthcare, Johns Hopkins University (K.H., P.H., J.Y.), Baltimore, Maryland.
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11
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Tran L, Vo J, Bell K, Perera S, Crowston J. Does Bevacizumab Improve Outcomes After Ahmed Glaucoma Valve Implantation for Refractory Glaucoma?: A Meta-Analysis. J Glaucoma 2024; 33:444-455. [PMID: 38194278 DOI: 10.1097/ijg.0000000000002357] [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: 07/18/2023] [Accepted: 12/27/2023] [Indexed: 01/10/2024]
Abstract
PRCIS Mean intraocular pressure (IOP), complete and overall success, mean IOP-lowering medications, incidence of hypertensive phase, and complications were found to be comparable between patients undergoing Ahmed glaucoma valve implantation (AGVI) with adjunctive bevacizumab versus AGVI alone. OBJECTIVE This meta-analysis aims to assess how adjunctive bevacizumab impacts the surgical outcomes of AGVI compared with AGVI alone in all subtypes of refractory glaucoma. METHODS A systematic search of databases for relevant randomized controlled trials (RCTs) was performed in March 2023. Primary outcomes included mean IOP and success rates. Secondary outcomes were mean IOP-lowering medications, incidence of hypertensive phase, and complications. Qualitative assessment, meta-analysis, subgroup analyses, and sensitivity analysis were performed. RESULTS Five RCTs comprising 203 eyes were included in the quantitative analysis. Initial meta-analysis showed a strong yet nonsignificant trend (all P > 0.05) favoring adjunctive bevacizumab in all outcomes of interest. Significant heterogeneity was observed for mean IOP and success outcomes at all time points (all I2 > 50%). Subgroup analysis of the administration route revealed a reduced incidence of hyphaema in the intravitreal bevacizumab subgroup (odds ratio: 0.10; 95% CI: 0.02 to 0.59; P = 0.01) with significant heterogeneity persisting in the intravitreal bevacizumab subgroup for all measures (all I2 > 50%). Post hoc sensitivity analysis of studies without concurrent pan-retinal photocoagulation for mean IOP and success outcomes demonstrated more conservative effect sizes with a corresponding decrease in heterogeneity for all measures (all I2 < 30%). CONCLUSION Published studies investigating the role of adjunctive bevacizumab show a strong trend to improve outcomes but contain a relatively small number of participants. This analysis underpins the need for an adequately powered RCT to explore the role of anti-vascular endothelial growth factor agents in AGVI surgery.
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Affiliation(s)
- Luke Tran
- Department of Ophthalmology, Royal Prince Alfred Hospital
| | - Joanne Vo
- Department of Ophthalmology, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | | | - Shamira Perera
- Singapore Eye Research Institute, Singapore National Eye Center
- Duke-NUS Medical School, Singapore
| | - Jonathan Crowston
- Department of Ophthalmology, Royal Prince Alfred Hospital
- NHMRC Clinical Trials Centre, University of Sydney
- Save Sight Institute, University of Sydney, Sydney, NSW
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12
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Huynh B, Kibret G, Wechsler D, Lee A, Lim R, Clement C, Lawlor M. Outcomes of iStent inject combined with cataract surgery in Asian eyes: Australian data from the Fight Glaucoma Blindness international registry. Int Ophthalmol 2024; 44:200. [PMID: 38662305 PMCID: PMC11358208 DOI: 10.1007/s10792-024-03104-x] [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: 10/18/2023] [Accepted: 03/24/2024] [Indexed: 04/26/2024]
Abstract
PURPOSE To analyse real-world outcomes in Asian eyes of iStent inject, a second-generation trabecular micro-bypass stent, combined with phacoemulsification. METHODS This is a multi-centre, observational study of glaucomatous Asian eyes that have undergone iStent inject implantation combined with cataract surgery. Patient data were extracted from the Fight Glaucoma Blindness! Registry. Outcome measures included those of IOP reduction, glaucoma medication reduction, and adverse events including the need for secondary surgery. RESULTS 123 eyes of 86 patients with a mean age of 68.4 ± 9.3 years underwent iStent inject implantation with phacoemulsification. At baseline, the mean ± SD preoperative intraocular pressure (IOP) was 16.0 ± 4.4 mmHg, and the mean preoperative number of topical glaucoma medications was 1.9 ± 1.4. At 12 months 30.8% of eyes demonstrated a reduction in IOP greater than 20%, the mean IOP reduction was 12.5% with an additional reduction of 0.7 glaucoma medications. 40% of eyes were using no medications at 12 months compared to 16.3% preoperatively. 8.2% of eyes required a subsequent procedure within the 12-month follow-up window. CONCLUSION iStent inject implantation combined with phacoemulsification in Asian eyes showed a reduction of IOP and glaucoma medication use in a real-world clinical setting. The safety profile of the device is good with minimal adverse outcomes, however, a subset of patients required secondary procedures within the 12 month follow up.
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Affiliation(s)
- Brandon Huynh
- Department of Ophthalmology, Sydney Eye Hospital, 8 Macquarie St, Sydney, NSW, Australia.
| | - Getiye Kibret
- Macquarie University, Sydney, Australia
- Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia
- University of Technology Sydney, Ultimo, Australia
| | - David Wechsler
- Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia
- Department of Ophthalmology, Concord Hospital, Sydney, Australia
- School of Advanced Medicine, Macquarie University, Sydney, Australia
| | - Anne Lee
- Department of Ophthalmology, Sydney Eye Hospital, 8 Macquarie St, Sydney, NSW, Australia
- Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia
- Faculty of Medicine and Health, University of New South Wales, Kensington, Australia
- Faculty of Medicine and Health, Western Sydney University, Penrith, Australia
- Department of Ophthalmology, Liverpool Hospital, Sydney, Australia
| | - Ridia Lim
- Department of Ophthalmology, Sydney Eye Hospital, 8 Macquarie St, Sydney, NSW, Australia
- Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia
| | - Colin Clement
- Department of Ophthalmology, Sydney Eye Hospital, 8 Macquarie St, Sydney, NSW, Australia
| | - Mitchell Lawlor
- Department of Ophthalmology, Sydney Eye Hospital, 8 Macquarie St, Sydney, NSW, Australia
- Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia
- Save Sight Institute, Sydney, Australia
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13
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Du Y. The Hippo signalling pathway and its impact on eye diseases. J Cell Mol Med 2024; 28:e18300. [PMID: 38613348 PMCID: PMC11015399 DOI: 10.1111/jcmm.18300] [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: 10/28/2023] [Revised: 02/26/2024] [Accepted: 03/25/2024] [Indexed: 04/14/2024] Open
Abstract
The Hippo signalling pathway, an evolutionarily conserved kinase cascade, has been shown to be crucial for cell fate determination, homeostasis and tissue regeneration. Recent experimental and clinical studies have demonstrated that the Hippo signalling pathway is involved in the pathophysiology of ocular diseases. This article provides the first systematic review of studies on the regulatory and functional roles of mammalian Hippo signalling systems in eye diseases. More comprehensive studies on this pathway are required for a better understanding of the pathophysiology of eye diseases and the development of effective therapies.
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Affiliation(s)
- Yuxiang Du
- Precision Medicine Laboratory for Chronic Non‐communicable Diseases of Shandong Province, Institute of Precision MedicineJining Medical UniversityJiningShandongPeople's Republic of China
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14
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Gniesmer S, Sonntag SR, Gapeeva A, Cojocaru A, Kaps S, Adelung R, Sewing J, Tura A, Grisanti S, Grisanti S. In vivo evaluation of a nanotechnology-based microshunt for filtering glaucoma surgery. Sci Rep 2024; 14:4452. [PMID: 38396005 PMCID: PMC10891163 DOI: 10.1038/s41598-024-54960-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 02/19/2024] [Indexed: 02/25/2024] Open
Abstract
To carry out the preclinical and histological evaluation of a novel nanotechnology-based microshunt for drainage glaucoma surgery. Twelve New Zealand White rabbits were implanted with a novel microshunt and followed up for 6 weeks. The new material composite consists of the silicone polydimethylsiloxane (PDMS) and tetrapodal Zinc Oxide (ZnO-T) nano-/microparticles. The microshunts were inserted ab externo to connect the subconjunctival space with the anterior chamber. Animals were euthanized after 2 and 6 weeks for histological evaluation. Ocular health and implant position were assessed at postoperative days 1, 3, 7 and twice a week thereafter by slit lamp biomicroscopy. Intraocular pressure (IOP) was measured using rebound tonometry. A good tolerability was observed in both short- and medium-term follow-up. Intraocular pressure was reduced following surgery but increased to preoperative levels after 2 weeks. No clinical or histological signs of inflammatory or toxic reactions were seen; the fibrotic encapsulation was barely noticeable after two weeks and very mild after six weeks. The new material composite PDMS/ZnO-T is well tolerated and the associated foreign body fibrotic reaction quite mild. The new microshunt reduces the IOP for 2 weeks. Further research will elucidate a tube-like shape to improve and prolong outflow performance and longer follow-up to exclude medium-term adverse effects.
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Affiliation(s)
- Stefanie Gniesmer
- Department of Ophthalmology, University of Luebeck, Luebeck, Germany.
| | | | - Anna Gapeeva
- Institute for Materials Science, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Ala Cojocaru
- Institute for Materials Science, Christian-Albrechts-University of Kiel, Kiel, Germany
- Phi-Stone AG, Kiel, Germany
| | - Sören Kaps
- Institute for Materials Science, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Rainer Adelung
- Institute for Materials Science, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Judith Sewing
- Department of Ophthalmology, University of Luebeck, Luebeck, Germany
| | - Aysegül Tura
- Department of Ophthalmology, University of Luebeck, Luebeck, Germany
| | | | - Swaantje Grisanti
- Department of Ophthalmology, University of Luebeck, Luebeck, Germany
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15
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You W, Knoops K, Boesten I, Berendschot TTJM, van Zandvoort MAMJ, Benedikter BJ, Webers CAB, Reutelingsperger CPM, Gorgels TGMF. A time window for rescuing dying retinal ganglion cells. Cell Commun Signal 2024; 22:88. [PMID: 38297331 PMCID: PMC10832163 DOI: 10.1186/s12964-023-01427-3] [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: 09/18/2023] [Accepted: 12/08/2023] [Indexed: 02/02/2024] Open
Abstract
BACKGROUND Retinal ganglion cell (RGC) degeneration and death cause vision loss in patients with glaucoma. Regulated cell death, once initiated, is generally considered to be an irreversible process. Recently, we showed that, by timely removing the cell death stimulus, stressed neuronal PC12 cells can recover from phosphatidylserine (PS) exposure, nuclear shrinkage, DNA damage, mitochondrial fragmentation, mitochondrial membrane potential loss, and retraction of neurites, all hallmarks of an activated cell death program. Whether the cell death process can be reversed in neurons of the central nervous system, like RGCs, is still unknown. Here, we studied reversibility of the activated cell death program in primary rat RGCs (prRGCs). METHODS prRGCs were exposed to ethanol (5%, vol/vol) to induce cell death. At different stages of the cell death process, ethanol was removed by washing and injured prRGCs were further cultured in fresh medium to see whether they recovered. The dynamics of single cells were monitored by high-resolution live-cell spinning disk microscopy. PS exposure, mitochondrial structure, membrane potential, and intracellular Ca2+ were revealed by annexin A5-FITC, Mito-tracker, TMRM, and Fluo 8-AM staining, respectively. The distribution of cytochrome c was investigated by immunofluorescence. The ultrastructure of mitochondria was studied by electron microscopy. RESULTS Analysis of temporal relationships between mitochondrial changes and PS exposure showed that fragmentation of the mitochondrial network and loss of mitochondrial membrane potential occurred before PS exposure. Mitochondrial changes proceeded caspase-independently, while PS exposure was caspase dependent. Interestingly, prRGCs recovered quickly from these mitochondrial changes but not from PS exposure at the plasma membrane. Correlative light and electron microscopy showed that stress-induced decrease in mitochondrial area, length and cristae number was reversible. Intracellular Ca2+ was elevated during this stage of reversible mitochondrial injury, but there was no sign of mitochondrial cytochrome c release. CONCLUSIONS Our study demonstrates that RGCs with impaired mitochondrial structure and function can fully recover if there is no mitochondrial cytochrome c release yet, and no PS is exposed at the plasma membrane. This finding indicates that there is a time window for rescuing dying or injured RGCs, by simply removing the cell death stimulus. Video Abstract.
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Affiliation(s)
- Wenting You
- University Eye Clinic Maastricht UMC+, Maastricht University Medical Center+, Maastricht, 6229 HX, The Netherlands
- Department of Biochemistry, CARIM School for Cardiovascular Disease, Maastricht University, Maastricht, 6229 ER, The Netherlands
- Department of Mental Health and Neuroscience, Maastricht University, Maastricht, 6229 ER, The Netherlands
| | - Kèvin Knoops
- The Microscopy CORE lab, Maastricht Multimodal Molecular Imaging Institute, Maastricht University, Maastricht, 6229 ER, The Netherlands
| | - Iris Boesten
- University Eye Clinic Maastricht UMC+, Maastricht University Medical Center+, Maastricht, 6229 HX, The Netherlands
| | - Tos T J M Berendschot
- University Eye Clinic Maastricht UMC+, Maastricht University Medical Center+, Maastricht, 6229 HX, The Netherlands
| | - Marc A M J van Zandvoort
- Department of Molecular Cell Biology, CARIM School for Cardiovascular Disease, Maastricht University, Maastricht, 6229 ER, The Netherlands
- Institute of Molecular Cardiovascular Research (IMCAR), Universitätsklinikum Aachen, 52074, Aachen, Germany
| | - Birke J Benedikter
- University Eye Clinic Maastricht UMC+, Maastricht University Medical Center+, Maastricht, 6229 HX, The Netherlands
| | - Carroll A B Webers
- University Eye Clinic Maastricht UMC+, Maastricht University Medical Center+, Maastricht, 6229 HX, The Netherlands
| | - Chris P M Reutelingsperger
- Department of Biochemistry, CARIM School for Cardiovascular Disease, Maastricht University, Maastricht, 6229 ER, The Netherlands.
| | - Theo G M F Gorgels
- University Eye Clinic Maastricht UMC+, Maastricht University Medical Center+, Maastricht, 6229 HX, The Netherlands.
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16
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Laroche D, Desrosiers A, Ng C. Short-term report of early glaucoma surgery with a clear lens extraction and an intraocular lens, OMNI canaloplasty, and a HYDRUS microstent: a case series in younger patients. FRONTIERS IN OPHTHALMOLOGY 2024; 3:1288052. [PMID: 38983083 PMCID: PMC11182160 DOI: 10.3389/fopht.2023.1288052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Accepted: 11/29/2023] [Indexed: 07/11/2024]
Abstract
Purpose The purpose of this case series is to report the surgical outcomes from the combination of a clear lensectomy, OMNI® canaloplasty, and a HYDRUS® microstent with an adjacent goniotomy. Methods This is a retrospective non-comparative single-center case series of four black patients of African descent with glaucoma who were treated with a clear lensectomy, OMNI canaloplasty, and a HYDRUS microstent with an adjacent goniotomy. The surgeries were performed by an experienced cataract and glaucoma surgeon, Daniel Laroche, MD. The parameters investigated in this study were postoperative intraocular pressure (IOP) and the mean number of preoperative and postoperative medications needed. Results The mean age of the four patients was 44.5 years. All patients had a mean postoperative reduction in IOP of 17 mmHg to 12.7 mmHg. The mean number of preoperative medications was 2.2, while the mean number of postoperative medications was 0.3. Potential complications such as hyphema, IOP spikes, or corneal edema were not seen in this series. All patients achieved a lower IOP and stable vision with less refractive error. Patients also experienced improved visual fields, clearer vision, and more open angles. Conclusion Clear lensectomy and combined microinvasive glaucoma surgery (MIGS) in patients with primary open-angle glaucoma (POAG) and narrow-angle glaucoma (NAG) results in the safe lowering of IOP. The limitations of this study include the small series size and the retrospective potential for bias. Further research with a larger series and a prospective trial with follow-up should be performed.
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Affiliation(s)
- Daniel Laroche
- Department of Ophthalmology, Icahn School of Medicine, Mount Sinai, New York, NY, United States
- Advanced Eye Care New York, New York, NY, United States
| | - Abelard Desrosiers
- City University of New York (CUNY) School of Medicine, New York, NY, United States
| | - Chester Ng
- Advanced Eye Care New York, New York, NY, United States
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17
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Aoyama Y, Sakata R, Fujishiro T, Honjo M, Shirato S, Aihara M. Contributing factors for intraocular pressure control in patients with mostly normal-tension glaucoma after initial Ex-PRESS drainage device implantation. Graefes Arch Clin Exp Ophthalmol 2024; 262:191-201. [PMID: 37624385 PMCID: PMC10806052 DOI: 10.1007/s00417-023-06209-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 07/11/2023] [Accepted: 08/11/2023] [Indexed: 08/26/2023] Open
Abstract
PURPOSE To investigate the postoperative intraocular pressure (IOP) control and identify the factors associated with failure of initial Ex-PRESS surgery in patients with open-angle glaucoma for 3 years. METHODS A total of 79 patients with medically uncontrolled open-angle glaucoma (55 normal-tension glaucoma and 24 primary open-angle glaucoma) were enrolled. All patients underwent Ex-PRESS implantation (including combined cataract surgery). The outcome measure was the survival rate using life table analysis, the failure was defined as IOP of > 18 mmHg (criterion A), > 15 mmHg (criterion B) or > 12 mmHg (criterion C) and/or IOP reduction of < 20% from baseline (each criterion) without any glaucoma medications. The Cox proportional hazards model was used to identify risk factors for IOP management defined as the above criterion. RESULTS: The mean preoperative IOP was 19.3 ± 5.8 mmHg. At 36 months, the mean IOP was 11.8 ± 3.6 mmHg with a mean IOP change of 7.5 mmHg (reduction rate 39.0%). The cumulative probability of success was 58% (95%CI: 42-64%) (criterion A), 48% (95%CI: 37-59%) (criterion B) and 30% (95%CI: 20-40%) (criterion C). In multivariate analyses, factors that predicted poor IOP control included the intervention of bleb needling after 6 months after the surgery (HR: 2.43; 95%CI: 1.35-4.37; P = 0.032). Transient hypotony was observed in 4 patients. CONCLUSION The implementation of bleb needling after Ex-PRESS surgery in the late postoperative period was suggested to be the main risk factor for achieving lower IOP.
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Affiliation(s)
- Yurika Aoyama
- Department of Ophthalmology, Graduate School of Medicine and Faculty of Medicine, The University of Tokyo, Tokyo, 113-8655, Japan
| | - Rei Sakata
- Department of Ophthalmology, Graduate School of Medicine and Faculty of Medicine, The University of Tokyo, Tokyo, 113-8655, Japan.
- Yotsuya Shirato Eye Clinic, Tokyo, Japan.
| | - Takashi Fujishiro
- Department of Ophthalmology, Graduate School of Medicine and Faculty of Medicine, The University of Tokyo, Tokyo, 113-8655, Japan
- Yotsuya Shirato Eye Clinic, Tokyo, Japan
| | - Megumi Honjo
- Department of Ophthalmology, Graduate School of Medicine and Faculty of Medicine, The University of Tokyo, Tokyo, 113-8655, Japan
- Yotsuya Shirato Eye Clinic, Tokyo, Japan
| | | | - Makoto Aihara
- Department of Ophthalmology, Graduate School of Medicine and Faculty of Medicine, The University of Tokyo, Tokyo, 113-8655, Japan
- Yotsuya Shirato Eye Clinic, Tokyo, Japan
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18
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Wang W, Wang H. Understanding the complex genetics and molecular mechanisms underlying glaucoma. Mol Aspects Med 2023; 94:101220. [PMID: 37856931 DOI: 10.1016/j.mam.2023.101220] [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: 06/29/2023] [Revised: 10/09/2023] [Accepted: 10/12/2023] [Indexed: 10/21/2023]
Abstract
Glaucoma is the leading cause of irreversible blindness worldwide. Currently the only effective treatment for glaucoma is to reduce the intraocular pressure, which can halt the progression of the disease. Highlighting the importance of identifying individuals at risk of developing glaucoma and those with early-stage glaucoma will help patients receive treatment before sight loss. However, some cases of glaucoma do not have raised intraocular pressure. In fact, glaucoma is caused by a variety of different mechanisms and has a wide range of different subtypes. Understanding other risk factors, the underlying mechanisms, and the pathology of glaucoma might lead to novel treatments and treatment of underlying diseases. In this review we present the latest research into glaucoma including the genetics and molecular basis of the disease.
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Affiliation(s)
- Weiwei Wang
- Shaanxi Eye Hospital, Xi'an People's Hospital (Xi'an Fourth Hospital), Affiliated People's Hospital, Northwest University, Xi'an, 710004, Shaanxi Province, China.
| | - Huaizhou Wang
- Department of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China
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19
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Xu M, Wang Y, Zhou J, Zhang X, Yu Y, Li K. MicroRNA-93 promotes the pathogenesis of glaucoma by inhibiting matrix metalloproteinases as well as up-regulating extracellular matrix and Rho/ROCK signaling pathways. Heliyon 2023; 9:e22012. [PMID: 38045197 PMCID: PMC10689882 DOI: 10.1016/j.heliyon.2023.e22012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 11/01/2023] [Accepted: 11/01/2023] [Indexed: 12/05/2023] Open
Abstract
Objective To investigate the effect and potential molecular mechanism of microRNA-93 (miR-93) on retinal ganglion cells (RGCs) apoptosis as well as retinal damage in acute glaucoma mice. Methods RGCs apoptosis were induced by oxygen-glucose deprivation and reperfusion (OGD/R). The pro-apoptotic effect of miR-93 was evaluated by transfecting miR-93 mimics or miR-93 inhibitor into OGD/R-induced RGCs. The viability and apoptosis of RGCs were determined by MTT assay and flow cytometry. Mouse model of acute glaucoma were successfully induced via high intraocular pressure (IOP), and then these model animals were randomly divided into vehicle group, miR-93 mimics group or miR-93 inhibitor group (n = 10), using healthy mice as normal control. Histopathologic changes of retinal tissue were evaluated by Hematoxylin and Eosin (H&E) staining method. Moreover, cell counts of retinal ganglion cell layer and mean thickness of different layers were also determined. Quantitative real-time PCR (qPCR) and western blotting analysis were used to detect the mRNA and protein expression levels of extracellular matrix (ECM), matrix metalloproteinases (MMPs) and Rho/ROCK signaling pathway. Results miR-93 mimics significantly decreased or promoted the viability and apoptosis of OGD/R-induced RGCs, respectively. In addition, miR-93 mimics significantly exacerbated the degree of retinal tissue damage in mice with acute glaucoma, which was accompanied by a decrease in the number of ganglion cell layer (GCL) cells and the thickness of different tissue layers. Moreover, miR-93 mimics significantly increased IOP in mice with acute glaucoma. Significantly, miR-93 inhibitors significantly reversed the above changes. In addition, results of Western blot analysis showed that miR-93 mimics increased and decreased the expression of ECM-associated and MMP-associated proteins, respectively, by activating the Rho/ROCK signaling pathway. In contrast, miR-93 significantly decreased and increased the expression of ECM-associated and MMP-associated proteins, and suppressed the expression of Rho/ROCK signaling pathway-related proteins. Conclusion miR-93 can promote the development of glaucoma by activating Rho/ROCK signaling pathway to mediate the accumulation of ECM-related proteins as well as the down-regulation of MMP-related proteins.
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Affiliation(s)
- Manhua Xu
- Department of Ophthalmology, Nanfang Hospital, Affiliated Hospital of Southwest Medical University, Luzhou, 646000, Sichuan Province, China
| | - Yanxi Wang
- Department of Ophthalmology, Nanfang Hospital, Affiliated Hospital of Southwest Medical University, Luzhou, 646000, Sichuan Province, China
| | - Juan Zhou
- Department of Ophthalmology, Nanfang Hospital, Affiliated Hospital of Southwest Medical University, Luzhou, 646000, Sichuan Province, China
| | - Xun Zhang
- Department of Ophthalmology, Nanfang Hospital, Affiliated Hospital of Southwest Medical University, Luzhou, 646000, Sichuan Province, China
| | - Yinggui Yu
- Department of Ophthalmology, Nanfang Hospital, Affiliated Hospital of Southwest Medical University, Luzhou, 646000, Sichuan Province, China
| | - Kaiming Li
- Department of Ophthalmology, Nanfang Hospital, Affiliated Hospital of Southwest Medical University, Luzhou, 646000, Sichuan Province, China
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Wu KY, Mina M, Carbonneau M, Marchand M, Tran SD. Advancements in Wearable and Implantable Intraocular Pressure Biosensors for Ophthalmology: A Comprehensive Review. MICROMACHINES 2023; 14:1915. [PMID: 37893352 PMCID: PMC10609220 DOI: 10.3390/mi14101915] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 09/27/2023] [Accepted: 09/28/2023] [Indexed: 10/29/2023]
Abstract
Glaucoma, marked by its intricate association with intraocular pressure (IOP), stands as a predominant cause of non-reversible vision loss. In this review, the physiological relevance of IOP is detailed, alongside its potential pathological consequences. The review further delves into innovative engineering solutions for IOP monitoring, highlighting the latest advancements in wearable and implantable sensors and their potential in enhancing glaucoma management. These technological innovations are interwoven with clinical practice, underscoring their real-world applications, patient-centered strategies, and the prospects for future development in IOP control. By synthesizing theoretical concepts, technological innovations, and practical clinical insights, this review contributes a cohesive and comprehensive perspective on the IOP biosensor's role in glaucoma, serving as a reference for ophthalmological researchers, clinicians, and professionals.
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Affiliation(s)
- Kevin Y. Wu
- Department of Surgery, Division of Ophthalmology, University of Sherbrooke, Sherbrooke, QC J1G 2E8, Canada; (K.Y.W.)
| | - Mina Mina
- Department of Mechanical and Manufacturing Engineering, University of Calgary, Calgary, AB T2N 1N4, Canada
| | - Marjorie Carbonneau
- Department of Surgery, Division of Ophthalmology, University of Sherbrooke, Sherbrooke, QC J1G 2E8, Canada; (K.Y.W.)
| | - Michael Marchand
- Department of Surgery, Division of Ophthalmology, University of Sherbrooke, Sherbrooke, QC J1G 2E8, Canada; (K.Y.W.)
| | - Simon D. Tran
- Faculty of Dental Medicine and Oral Health Sciences, McGill University, Montreal, QC H3A 1G1, Canada
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Sharfuddin Ahmed M, Ullah AY, Barman N, Ratan ZA, Mostafa S, Khaleque A, Kabir S, Khan MH, Haque MA. Risk factors associated with elevated intraocular pressure: a population-based study in a rural community of Bangladesh. BMJ Open Ophthalmol 2023; 8:e001386. [PMID: 37844969 PMCID: PMC10582991 DOI: 10.1136/bmjophth-2023-001386] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 09/25/2023] [Indexed: 10/18/2023] Open
Abstract
OBJECTIVE High intraocular pressure (IOP) is one of the major modifiable risk factors for glaucoma. The objective was to examine socio-demographic and clinical factors related to IOP. METHODS AND ANALYSIS This study was conducted among 3097 adults residing in a rural area of Bangladesh, with all participants undergoing clinical and ophthalmological evaluations. The measurement of IOP was carried out using of a rebound Tonometer called Icare pro. Multiple logistic regression analysis was employed to identify variables associated to IOP levels of 21 mm Hg or above. Adjusted OR (aOR) and 95% CI were reported. RESULTS This study found that, in total, 9% of the study population had high IOP in one or both eyes. Elevated IOP was significantly associated with respondents who were service holders (aOR 2.52; 95% CI 1.48 to 4.31), had a lower education level (aOR 1.55, 95% CI 1.07 to 2.23), used biomass fuel (aOR 2.00; 95% CI 1.09 to 3.67), belonged to a higher socioeconomic position (aOR 1.55, 95% CI 1.07 to 2.23) and had obesity (aOR 2.00; 95% CI 1.07 to 3.73), hypertension (aOR 1.32; 95% CI 1.01 to 1.73) or history of diabetes (aOR 2.44; 95% CI 1.67 to 3.55), after adjusting for covariates including age, sex, marital status, light source and tobacco consumption, in a multiple regression analysis. CONCLUSION Chronic diseases, such as hypertension and diabetes, obesity and sociodemographic characteristics such as high socioeconomic status and use of biomass fuels, have all been linked to elevated IOP. Patients with chronic diseases should undergo for IOP testing regularly.
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Affiliation(s)
- Md Sharfuddin Ahmed
- Department of Ophthalmology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Abm Yasin Ullah
- Department of Vitreo-Retina, National Institute of Ophthalmology and Hospital, Dhaka, Bangladesh
| | - Nilima Barman
- Department of Laboratory Medicine, Bangladesh Institute of Research and Rehabilitation of Diabetes Endocrine and Metabolic Disorders, Dhaka, Bangladesh
| | - Zubair Ahmed Ratan
- Department of Biomedical Engineering, Khulna University of Engineering and Technology, Khulna, Bangladesh
| | | | - Abdul Khaleque
- Department of Ophthalmology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Showkat Kabir
- Department of Ophthalmology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Maruf Haque Khan
- Department of Public Health and Informatics, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - M Atiqul Haque
- Department of Public Health and Informatics, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
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Espaillat A. Outcomes of 60-Degree Nasal Goniotomy for Open Angle Glaucoma. J Glaucoma 2023; 32:e129-e134. [PMID: 37523635 DOI: 10.1097/ijg.0000000000002266] [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: 01/10/2023] [Accepted: 07/08/2023] [Indexed: 08/02/2023]
Abstract
PRCIS Sixty-degree nasal sectoral juxtacanalicular space goniotomy with the single-use Espaillat juxtacanalicular space slider device significantly reduced intraocular pressure and the number of required glaucoma hypotensive medications, with sustained reductions over 24 months. PURPOSE This study analyzed the safety and efficacy of the Espaillat juxtacanalicular space slider during minimally invasive 60-degree nasal sectoral goniotomy for mild-to-moderate open angle glaucoma (OAG). PATIENTS AND METHODS This prospective, observational case series performed at a private clinical practice and outpatient surgery center assessed the eyes of patients with mild-to-moderate OAG who underwent phacoemulsification cataract surgery with 60-degree nasal sectoral goniotomy using the Espaillat juxtacanalicular space slider. The same surgeon performed all procedures. Intraocular pressure, intraocular pressure-lowering drugs, and adverse effects were assessed over 24 months, and a regression analysis of intraocular pressure reduction was performed. Success was defined as (1) A reduction in the intraocular pressure of at least 20% for at least 12 months, compared with the baseline value, and (2) a decrease in the number of medications by at least one for at least 12 months. RESULTS Among 38 eyes, 27 (72%) had moderate glaucoma, and 11 (28%) had mild glaucoma. Postoperatively, intraocular pressure was decreased by 38% at 12 months (mean 13.7±1.7 mmHg), 35% at 18 months (mean 14.4±1.8 mmHg), and 31% at 24 months (mean 15.2±1.9 mmHg). In addition, the number of topical glaucoma medications used decreased from a mean of 1.6 to 0.4 ( P <0.001). The main adverse event was temporary focal corneal edema (29 patients; 76%). CONCLUSIONS Using the Espaillat juxtacanalicular space slider during invasive 60-degree nasal sectoral goniotomy for OAG yielded a significant and sustained reduction in intraocular pressure and reduced the need for glaucoma medications with minimal adverse events.
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Ahmed A, Jammal AA, Estrela T, Berchuck SI, Medeiros FA. Intraocular Pressure and Rates of Macular Thinning in Glaucoma. Ophthalmol Glaucoma 2023; 6:457-465. [PMID: 37037307 PMCID: PMC10523920 DOI: 10.1016/j.ogla.2023.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 03/21/2023] [Accepted: 03/31/2023] [Indexed: 04/12/2023]
Abstract
PURPOSE To evaluate the effect of intraocular pressure (IOP) on the rates of macular thickness (ganglion cell layer [GCL] and ganglion cell-inner plexiform layer [GCIPL]) change over time measured by spectral-domain (SD) OCT. DESIGN Retrospective cohort study. PARTICIPANTS Overall, 451 eyes of 256 patients with primary open-angle glaucoma. METHODS Data were extracted from the Duke Ophthalmic Registry, a database of electronic medical records of patients observed under routine clinical care at the Duke Eye Center, and satellite clinics. All records from patients with a minimum of 6 months of follow-up and at least 2 good-quality Spectralis SD-OCT macula scans were included. Linear mixed models were used to investigate the relationship between average IOP during follow-up and rates of GCL and GCIPL thickness change over time. MAIN OUTCOME MEASURES The effect of IOP on the rates of GCL and GCIPL thickness loss measured by SD-OCT. RESULTS Eyes had a mean follow-up of 1.8 ± 1.3 years, ranging from 0.5 to 10.2 years. The average rate of change for GCL thickness was -0.220 μm/year (95% confidence interval [CI], -0.268 to -0.172 μm/year) and for GCIPL thickness was -0.231 μm/year (95% CI, -0.302 to -0.160 μm/year). Each 1-mmHg higher mean IOP during follow-up was associated with an additional loss of -0.021 μm/year of GCL thickness (P = 0.001) and -0.032 μm/year of GCIPL thickness (P = 0.001) after adjusting for potentially confounding factors, such as baseline age, disease severity, sex, race, central corneal thickness, and follow-up time. CONCLUSIONS Higher IOP was significantly associated with faster rates of GCL and GCIPL loss over time measured by SD-OCT, even during relatively short follow-up times. These findings support the use of SD-OCT GCL and GCIPL thickness measurements as structural biomarkers for the evaluation of the efficacy of IOP-lowering therapies in slowing down the progression of glaucoma. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- Abia Ahmed
- Vision, Imaging, and Performance Laboratory, Duke Eye Center and Department of Ophthalmology, Duke University, Durham, North Carolina; Department of Biology, University of North Carolina, Chapel Hill, North Carolina
| | - Alessandro A Jammal
- Vision, Imaging, and Performance Laboratory, Duke Eye Center and Department of Ophthalmology, Duke University, Durham, North Carolina
| | - Tais Estrela
- Vision, Imaging, and Performance Laboratory, Duke Eye Center and Department of Ophthalmology, Duke University, Durham, North Carolina
| | - Samuel I Berchuck
- Vision, Imaging, and Performance Laboratory, Duke Eye Center and Department of Ophthalmology, Duke University, Durham, North Carolina; Department of Statistical Science and Forge, Duke University, Durham, North Carolina
| | - Felipe A Medeiros
- Vision, Imaging, and Performance Laboratory, Duke Eye Center and Department of Ophthalmology, Duke University, Durham, North Carolina; Department of Electrical and Computer Engineering, Pratt School of Engineering, Duke University, Durham, North Carolina.
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Fujita A, Hashimoto Y, Okada A, Matsui H, Yasunaga H, Aihara M. Practice patterns and costs of glaucoma treatment in Japan. Jpn J Ophthalmol 2023; 67:590-601. [PMID: 37354251 DOI: 10.1007/s10384-023-01002-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 04/26/2023] [Indexed: 06/26/2023]
Abstract
PURPOSE Understanding the practice patterns and costs of glaucoma care in real-world clinical settings is important for optimizing medical expenses. However, glaucoma treatment trends and associated costs in Japan are unknown. We aimed to unveil glaucoma treatment trends and costs using a large administrative claims database in Japan. STUDY DESIGN Retrospective cohort study. METHODS We included patients diagnosed with glaucoma between April 2014 and March 2021 using the DeSC database. We calculated the frequencies and costs of antiglaucoma eyedrops, incisional or laser procedures, and ophthalmic examinations stratified by fiscal year and age. In the year-by-year analyses, the age distribution was standardized based on the 2020 distribution. RESULTS A total of 841,747 patient-years (429,051 patients) were included. The number of prescribed eyedrops significantly increased and the fixed-combination eyedrops proportion decreased with age. Trabeculectomy frequency decreased, and that of laser trabeculoplasty increased during the observation period. The frequencies of both incisional and laser procedures peaked in the 75-79 age group. In 2020, 16.1 bottles of eyedrops per patient-year were prescribed, and 15.9 incisional surgeries and 11.3 laser therapies were performed per 1000 patient-years. Intraocular pressure measurement and visual field testing were performed 6.5 times and 2.0 times per patient-year, respectively. The total direct cost of glaucoma treatment was 55,139 yen (US $399.5) per patient-year, of which medications accounted for 44.2%, ophthalmic examinations for 47.4%, and incisional or laser procedures for 8.4%. CONCLUSION These results may be useful for understanding glaucoma treatment trends and costs in Japan.
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Affiliation(s)
- Asahi Fujita
- Department of Clinical Epidemiology and Health Economics, School of Public Health, University of Tokyo, Tokyo, Japan.
- Department of Ophthalmology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
| | - Yohei Hashimoto
- Department of Clinical Epidemiology and Health Economics, School of Public Health, University of Tokyo, Tokyo, Japan
- Department of Ophthalmology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Akira Okada
- Department of Prevention of Diabetes and Lifestyle-Related Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, University of Tokyo, Tokyo, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, University of Tokyo, Tokyo, 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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Buonfiglio F, Pfeiffer N, Gericke A. Immunomodulatory and Antioxidant Drugs in Glaucoma Treatment. Pharmaceuticals (Basel) 2023; 16:1193. [PMID: 37765001 PMCID: PMC10535738 DOI: 10.3390/ph16091193] [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: 07/14/2023] [Revised: 08/02/2023] [Accepted: 08/18/2023] [Indexed: 09/29/2023] Open
Abstract
Glaucoma, a group of diseases characterized by progressive retinal ganglion cell loss, cupping of the optic disc, and a typical pattern of visual field defects, is a leading cause of severe visual impairment and blindness worldwide. Elevated intraocular pressure (IOP) is the leading risk factor for glaucoma development. However, glaucoma can also develop at normal pressure levels. An increased susceptibility of retinal ganglion cells to IOP, systemic vascular dysregulation, endothelial dysfunction, and autoimmune imbalances have been suggested as playing a role in the pathophysiology of normal-tension glaucoma. Since inflammation and oxidative stress play a role in all forms of glaucoma, the goal of this review article is to present an overview of the inflammatory and pro-oxidant mechanisms in the pathophysiology of glaucoma and to discuss immunomodulatory and antioxidant treatment approaches.
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Affiliation(s)
- Francesco Buonfiglio
- Department of Ophthalmology, University Medical Center, Johannes Gutenberg University Mainz, Langenbeckstrasse 1, 55131 Mainz, Germany;
| | | | - Adrian Gericke
- Department of Ophthalmology, University Medical Center, Johannes Gutenberg University Mainz, Langenbeckstrasse 1, 55131 Mainz, Germany;
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Pereira ICF, van Mechelen RJS, Wyss HM, Pinchuk L, Beckers HJM, den Toonder JMJ. Magnetically actuated glaucoma drainage device for regulating intraocular pressure after implantation. MICROSYSTEMS & NANOENGINEERING 2023; 9:92. [PMID: 37484503 PMCID: PMC10356933 DOI: 10.1038/s41378-023-00561-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 05/10/2023] [Accepted: 05/18/2023] [Indexed: 07/25/2023]
Abstract
The key risk factor for glaucoma is increased intraocular pressure (IOP). Glaucoma drainage devices implanted in the eye can reduce IOP and thus stop disease progression. However, most devices currently used in clinical practice are passive and do not allow for postsurgical IOP control, which may result in serious complications such as hypotony (i.e., excessively low IOP). To enable noninvasive IOP control, we demonstrate a novel, miniature glaucoma implant that will enable the repeated adjustment of the hydrodynamic resistance after implantation. This is achieved by integrating a magnetic microvalve containing a micropencil-shaped plug that is moved using an external magnet, thereby opening or closing fluidic channels. The microplug is made from biocompatible poly(styrene-block-isobutylene-block-styrene) (SIBS) containing iron microparticles. The complete implant consists of an SIBS drainage tube and a housing element containing the microvalve and fabricated with hot embossing using femtosecond laser-machined glass molds. Using in vitro and ex vivo microfluidic experiments, we demonstrate that when the microvalve is closed, it can provide sufficient hydrodynamic resistance to overcome hypotony. Valve function is repeatable and stable over time. Due to its small size, our implant is a promising, safe, easy-to-implant, minimally invasive glaucoma surgery device.
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Affiliation(s)
- Inês C. F. Pereira
- Microsystems, Department of Mechanical Engineering, Eindhoven University of Technology, 5600MB Eindhoven, The Netherlands
- Institute for Complex Molecular Systems (ICMS), Eindhoven University of Technology, 5600MB Eindhoven, The Netherlands
| | - Ralph J. S. van Mechelen
- University Eye Clinic Maastricht, Maastricht University Medical Centre+ (MUMC+), 6202AZ Maastricht, The Netherlands
| | - Hans M. Wyss
- Microsystems, Department of Mechanical Engineering, Eindhoven University of Technology, 5600MB Eindhoven, The Netherlands
- Institute for Complex Molecular Systems (ICMS), Eindhoven University of Technology, 5600MB Eindhoven, The Netherlands
| | - Leonard Pinchuk
- InnFocus, Inc., a Santen Company, Miami, Florida 33186 USA
- Ophthalmic Biophysics Center, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida 33136 USA
| | - Henny J. M. Beckers
- University Eye Clinic Maastricht, Maastricht University Medical Centre+ (MUMC+), 6202AZ Maastricht, The Netherlands
| | - Jaap M. J. den Toonder
- Microsystems, Department of Mechanical Engineering, Eindhoven University of Technology, 5600MB Eindhoven, The Netherlands
- Institute for Complex Molecular Systems (ICMS), Eindhoven University of Technology, 5600MB Eindhoven, The Netherlands
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Sharif NA. Identifying new drugs and targets to treat rapidly elevated intraocular pressure for angle closure and secondary glaucomas to curb visual impairment and prevent blindness. Exp Eye Res 2023; 232:109444. [PMID: 36958427 DOI: 10.1016/j.exer.2023.109444] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 02/23/2023] [Accepted: 03/16/2023] [Indexed: 03/25/2023]
Abstract
A multitude of pharmacological compounds have been shown to lower and control intraocular pressure (IOP) in numerous species of animals and human subjects after topical ocular dosing or via other routes of administration. Most researchers have been interested in finding drug candidates that exhibit a relatively long duration of action from a chronic therapeutic use perspective, for example to treat ocular hypertension (OHT), primary open-angle glaucoma and even normotensive glaucoma. However, it is equally important to seek and characterize treatment modalities which offer a rapid onset of action to help provide fast relief from quickly rising IOP that occurs in certain eye diseases. These include acute angle-closure glaucoma, primary angle-closure glaucoma, uveitic and inflammatory glaucoma, medication-induced OHT, and other secondary glaucomas induced by eye injury or infection which can cause partial or complete loss of eyesight. Such fast-acting agents can delay or prevent the need for ocular surgery which is often used to lower the dangerously raised IOP. This research survey was therefore directed at identifying agents from the literature that demonstrated ocular hypotensive activity, normalizing and unifying the data, determining their onset of action and rank ordering them on the basis of rapidity of action starting within 30-60 min and lasting up to at least 3-4 h post topical ocular dosing in different animal species. This research revealed a few health authority-approved drugs and some investigational compounds that appear to meet the necessary criteria of fast onset of action coupled with significant efficacy to reduce elevated IOP (by ≥ 20%, preferably by >30%). However, translation of the novel animal-based findings to the human conditions remains to be demonstrated but represent viable targets, especially EP2-receptor agonists (e.g. omidenepag isopropyl; AL-6598; butaprost), mixed activity serotonin/dopamine receptor agonists (e.g. cabergoline), rho kinase inhibitors (e.g. AMA0076, Y39983), CACNA2D1-gene product inhibitors (e.g. pregabalin), melatonin receptor agonists, and certain K+-channel openers (e.g. nicorandil, pinacidil). Other drug candidates and targets were also identified and will be discussed.
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Affiliation(s)
- Najam A Sharif
- Institute of Ophthalmology, University College London (UCL), London, UK; Imperial College of Science and Technology, St. Mary's Campus, London, UK; Eye-ACP Duke-National University of Singapore Medical School, Singapore; Singapore Eye Research Institute (SERI), Singapore; Department of Pharmacy Sciences, Creighton University, Omaha, NE, USA; Department of Pharmacology and Neuroscience, University of North Texas Health Sciences Center, Fort Worth, Texas, USA; Department of Pharmaceutical Sciences, College of Pharmacy and Health Sciences, Texas Southern University, Houston, Texas, USA; Ophthalmology Innovation Center, Santen Inc USA, Emeryville, CA, USA.
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Bhatnagar KR, Shakrawal J. Management of glaucoma patients at a tertiary care hospital during the COVID-19 pandemic in Western India. Indian J Ophthalmol 2023; 71:2306-2307. [PMID: 37202988 PMCID: PMC10391373 DOI: 10.4103/ijo.ijo_2867_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2023] Open
Affiliation(s)
- Kavita R Bhatnagar
- Department of Ophthalmology, All India Institute of Medical Sciences (AIIMS), Jodhpur, Rajasthan, India
| | - Jyoti Shakrawal
- Department of Ophthalmology, All India Institute of Medical Sciences (AIIMS), Jodhpur, Rajasthan, India
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Yadgari M, Ghanbarnia MJ. Impact of postoperative choroidal detachment on trabeculectomy outcomes: a four-year comparative study. BMC Ophthalmol 2023; 23:111. [PMID: 36932410 PMCID: PMC10024434 DOI: 10.1186/s12886-023-02860-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 03/14/2023] [Indexed: 03/19/2023] Open
Abstract
BACKGROUND The aim of this study was to compare trabeculectomy outcomes in patients with and without post-operative serous choroidal detachment (CD) and establish an association between CD and trabeculectomy outcomes. METHODS In this 4-year retrospective cohort study, medical records of glaucoma patients older than 18 who underwent primary trabeculectomy with Mitomycin-C between 2012 and 2020 were reviewed. Phakic eyes without history of any other intraocular surgery and with at least one year of follow-up were included in the study. Postoperative CD was defined as clinically visible CD developed within the first postoperative week. Cases were categorized into with and without CD and trabeculectomy outcomes were compared. Comparison was carried out using postoperative intraocular pressure (IOP), glaucoma medications and surgery success. Two levels of success were defined regardless of glaucoma medications; criteria A) 5 < IOP < 19 mmHg and criteria B) 5 < IOP < 16 mmHg. In addition to the defined IOP ranges, IOP reduction less than 20% from baseline and further glaucoma surgery were also counted as surgery failures. RESULTS Total of 183 patients including 153 without CD (mean age 58.73 ± 11.40 years, mean IOP 23.7 ± 6.63 mmHg) and 30 with CD (59.00 ± 12.59 years, mean IOP 22.2 ± 3.83 mmHg) entered the study. Post-trabeculectomy mean IOPs were significantly higher in the CD group at all follow-up visits at year 1 through 4 (14.70, and 14.82 mmHg vs. 11.03, and 12.59 mmHg; p-value < 0.05). Similarly mean number of glaucoma medications was higher in the CD group at all follow-up visits (p-value > 0.001). Based on success criteria A, cumulative probability of success for patients with CD wasn't significantly different compared to those without CD at years 1 through 4 (80.0%, and 69.6% vs. 88.2%, and 74.1% respectively; p-value > 0.05, log-rank). However, based on success criteria B, patients with CD had significantly lower cumulative probability of success at years 1 through 4 (50.0% and 8.9% vs. 79.7% and 59.8%, p-value < 0.001). CONCLUSION We established that early post-trabeculectomy serous choroidal detachment is associated with adverse surgery outcomes. Lower rate of surgery success and higher mean postoperative IOP and glaucoma medications were observed in patients with post-trabeculectomy choroidal detachment and this was more pronounced in patients who required more stringent IOP control (success definition 5 < IOP < 16 mmHg).
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Affiliation(s)
- Maryam Yadgari
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Ophthalmology, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Ćwiklińska-Haszcz A, Żarnowski T, Wróbel-Dudzińska D, Kosior-Jarecka E. The Efficacy and Safety of the GATT Procedure in Open-Angle Glaucoma-6-Month Results. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2759. [PMID: 36768125 PMCID: PMC9914959 DOI: 10.3390/ijerph20032759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 01/30/2023] [Accepted: 02/01/2023] [Indexed: 06/18/2023]
Abstract
AIM The aim of the study was to retrospectively evaluate the efficacy and safety of GATT during a 6-month observation period. MATERIAL AND METHODS The studied group consisted of 69 open-angle glaucoma patients treated with GATT as the only procedure or in combination with cataract surgery. Patients were assessed 1 day, 10 days, 1 month, 3 months, and 6 months after the surgery via standard ophthalmic examination including VF, IOP, and BCVA. The number of medications taken daily and possible complications were checked. Two criteria of success were established (S1: IOP decrease by 30% and S2: IOP lower than 18 mm Hg). RESULTS Before the surgery, the mean IOP was 26.94 mmHg and significantly decreased after GATT to 15.59 mmHg at 6M. BCVA did not significantly differ between the visits. The mean MD did not change significantly within the 6-month observation period (-8.20 dB vs. -8.16 dB, p = 0.9824), similar to the mean VFI (64.31% vs. 63.05%, p = 0.8571). A 30% IOP decrease at 6M visit was obtained in 95.6% of patients, and 37.7% needed medications to stabilize IOP. An IOP lower than 18 mmHg at 6M was obtained in 91.3% of studied patients after the GATT procedure, and in 58.0% without additional medications. The mean number of medications received daily decreased significantly at 6M compared to preoperative results (2.59 at inclusion vs. 0.76 at 6M, p = 0.0004). The most frequent complication after surgery was hyphema, which resolved spontaneously within 10 days. CONCLUSION The 6-month observation showed that GATT is a minimally invasive glaucoma-surgery technique that enables an effective and safe IOP decrease.
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Chen XL, Fu YJ, Qu B, Wang YW, Tang X, Wang YH, Zhou GY, Lin MK, Shen JY, Yao J, Li SY, Wu MQ, Peng HZ, Lai MY, Wu RY, Zhang YN, Li Y, Wu XJ, Zhang MC, Guo SP, Sun XH. Safety profile of 0.0015% tafluprost eye drops in China: a post-marketing observational study. Int J Ophthalmol 2023; 16:108-114. [PMID: 36659941 PMCID: PMC9815987 DOI: 10.18240/ijo.2023.01.16] [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: 07/11/2022] [Accepted: 10/21/2022] [Indexed: 12/29/2022] Open
Abstract
AIM To investigate the treatment pattern and safety of tafluprost for glaucoma and ocular hypertension (OH) in clinical practice in China. METHODS This post-marketing observational study included patients who received tafluprost to lower intraocular pressure (IOP) within 30d between September 2017 and March 2020 in 20 hospitals in China. Adverse drug reactions (ADRs) during tafluprost treatment and within 30d after the treatment were collected. RESULTS A total of 2544 patients were included in this study, of them 58.5% (1488/2544) had primary open angle glaucoma (POAG), 21.9% (556/2544) had OH and 19.7% (500/2544) used tafluprost for other reasons. Of 359 ADRs occurred in 10.1% (258/2544) patients, and no serious adverse event occurred. The most common ADR was conjunctival hyperemia (128 ADRs in 124 patients, 4.9%). Totally 1670 participants (65.6%) combined tafluprost with carbonic anhydrase inhibitors (CAIs; 37.1%, 620/1670), sympathomimetics (33.5%, 559/1670), β-blockers (33.2%, 555/1670), other prostaglandin analogs (PGAs; 15.6%, 260/1670) and other eye drops (15.1%, 253/1670). The highest incidence of conjunctival hyperemia was noted in patients who received tafluprost in combination with other PGAs (23 ADRs in 23 patients, 8.8%, 23/260) and the lowest was in combination with CAIs (16 ADRs in 16 patients, 2.6%, 16/620). Tafluprost was applied in primary angle-closure glaucoma (41.6%, 208/500), after glaucoma surgery (17.8%, 89/500) and after non-glaucoma surgery (15.8%, 79/500). CONCLUSION Tafluprost is safe for POAG and OH, and tolerable when combined with other eye drops and under various clinical circumstances.
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Affiliation(s)
- Xue-Li Chen
- Department of Ophthalmology, Eye & ENT Hospital of Fudan University, Shanghai 200000, China
| | - Yan-Jing Fu
- Department of Ophthalmology, Daqing Ophthalmologic Hospital, Daqing 163000, Heilongjiang Province, China
| | - Bo Qu
- Department of Ophthalmology, the Fourth Affiliated Hospital of China Medical University, Shenyang 110000, Liaoning Province, China
| | - Ye-Wei Wang
- Department of Ophthalmology, Da Lian He Eye Specialist Hospital, Dalian 116000, Liaoning Province, China
| | - Xin Tang
- Department of Ophthalmology, Beijing Tongren Hospital, Beijing 100000, China
| | - Yu-Hong Wang
- Department of Ophthalmology, Xiamen Eye Center of Xiamen University, Xiamen 361000, Fujian Province, China
| | - Guo-Yi Zhou
- Department of Ophthalmology, Yueqing People's Hospital, Wenzhou 325600, Zhejiang Province, China
| | - Ming-Kai Lin
- Department of Glaucoma, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510000, Guangdong Province, China
| | - Jing-Yuan Shen
- Department of Ophthalmology, Shengzhou Shen's Eye Hospital, Shaoxing 312400, Zhejiang Province, China
| | - Jin Yao
- Department of Ophthalmology, the Affiliated Eye Hospital of Nanjing Medical University, Nanjing 210000, Jiangsu Province, China
| | - Su-Yan Li
- Department of Ophthalmology, Xuzhou No.1 Peoples Hospital, Xuzhou 221000, Jiangsu Province, China
| | - Miao-Qin Wu
- Department of Ophthalmology, Zhejiang Provincial People's Hospital, Hangzhou 310000, Zhejiang Province, China
| | - Hua-Zong Peng
- Department of Ophthalmology, Wuhan Eyegood Ophthalmic Hospital, Wuhan 430014, Hubei Province, China
| | - Ming-Ying Lai
- Department of Ophthalmology, Shenzhen Eye Hospital, Shenzhen 518001, Guangdong Province, China
| | - Ren-Yi Wu
- Department of Glaucoma, Shanghai Heping Eye Hospital, Shanghai 200000, China
| | - Yi-Nong Zhang
- Department of Ophthalmology, Wuxi Second People's Hospital, Wuxi 214000, Jiangsu Province, China
| | - Yan Li
- Department of Ophthalmology, First Affiliated Hospital of Kunming Medical University, Kunming 650000, Yunnan Province, China
| | - Xiao-Jun Wu
- Department of Ophthalmology, Union Shenzhen Hospital (Nanshan Hospital), Shenzhen 518000, Guangdong Province, China
| | - Ming-Chang Zhang
- Department of Ophthalmology, Wuhan Union Hospital, Wuhan 430000, Hubei Province, China
| | - Su-Ping Guo
- Department of Ophthalmology, Shengyang He Eye Specialist Hospital, Shenyang 110000, Liaoning Province, China
| | - Xing-Huai Sun
- Department of Ophthalmology, Eye & ENT Hospital of Fudan University, Shanghai 200000, China
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Suzuki Junior ER, Maestrini HA, Ruppert ADP, Seixas RCS, Belfort AF, de Miranda Santos HD, Basile Neto A, Balbino M, Lopes da Silva MJ. A Retrospective Comparison of Ahmed Glaucoma Valve Implants with or without Ologen Collagen Matrix. Clin Ophthalmol 2023; 17:15-23. [PMID: 36627928 PMCID: PMC9826637 DOI: 10.2147/opth.s396330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 12/29/2022] [Indexed: 01/05/2023] Open
Abstract
Purpose To study the effects of Ologen collagen matrix on the outcomes of the Ahmed glaucoma valve implant. Study Design Retrospective case-control multicenter study, conducted at four centers, comparing the 6-month outcomes of Ahmed valve implants with or without Ologen. Participants The study included 125 eyes in a 4:1 pairing (25 patients with Ologen matched to 100 patients without Ologen). Intervention Ologen was placed over the Ahmed plate in the study group. Success was defined as an intraocular pressure (IOP) ≤ 21 mmHg either with no medication (complete success) or regardless of medications (qualified success). Other outcomes included IOP variation, eye drop use, and surgical complications. Results Overall, the IOP decreased from 30.72 ± 9.08 to 16.14 ± 4.79 mmHg (p=0.0001). Of the 125 eyes, 26 achieved complete success and 94 achieved qualified success. There was no difference in complete success between the groups (p=0.12); however, there was a difference in qualified success (p=0.01), with better results in the no-Ologen group (80% vs 56%). There were no differences in the decrease in medications (p=0.06), as well as the incidence of complications (p=0.69). Although the need for postoperative surgical reintervention was higher in the no-Ologen group (13% vs 4%), the difference was not significant (p=0.2). Conclusion The reductions in IOP and number of medications were similar in both groups after 6 months, with similar complication rates. The qualified success rate was lower in the Ologen group, but further studies are needed to clarify the role of Ologen in Ahmed valve implants.
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Affiliation(s)
| | | | | | | | - Ana Flávia Belfort
- Department of Ophthalmology, Clínica de Olhos da Santa Casa de Belo Horizonte, Belo Horizonte, MG, Brazil
| | | | - Alberto Basile Neto
- Department of Ophthalmology, Complexo Hospitalar Padre Bento de Guarulhos, Guarulhos, SP, Brazil
| | - Marcos Balbino
- Department of Emergency Medicine, Centro Universitário São Camilo, São Paulo, SP, Brazil,Correspondence: Marcos Balbino, Department of Emergency Medicine, Centro Universitário São Camilo, Cipriano Barata, 1869 – ap. 93. Ipiranga, São Paulo, 04205001, Brazil, Tel +5511-983462354, Email
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Jaumandreu L, Antón A, Pazos M, Rodriguez-Uña I, Rodriguez Agirretxe I, Martinez de la Casa JM, Ayala ME, Parrilla-Vallejo M, Dyrda A, Díez-Álvarez L, Rebolleda G, Muñoz-Negrete FJ. Glaucoma progression. Clinical practice guide. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2023; 98:40-57. [PMID: 36089479 DOI: 10.1016/j.oftale.2022.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Accepted: 05/19/2022] [Indexed: 01/11/2023]
Abstract
OBJECTIVE To provide general recommendations that serve as a guide for the evaluation and management of glaucomatous progression in daily clinical practice based on the existing quality of clinical evidence. METHODS After defining the objectives and scope of the guide, the working group was formed and structured clinical questions were formulated following the PICO (Patient, Intervention, Comparison, Outcomes) format. Once all the existing clinical evidence had been independently evaluated with the AMSTAR 2 (Assessment of Multiple Systematic Reviews) and Cochrane "Risk of bias" tools by at least two reviewers, recommendations were formulated following the Scottish Intercollegiate Guideline network (SIGN) methodology. RESULTS Recommendations with their corresponding levels of evidence that may be useful in the interpretation and decision-making related to the different methods for the detection of glaucomatous progression are presented. CONCLUSIONS Despite the fact that for many of the questions the level of scientific evidence available is not very high, this clinical practice guideline offers an updated review of the different existing aspects related to the evaluation and management of glaucomatous progression.
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Affiliation(s)
- L Jaumandreu
- Servicio de Oftalmología, Hospital Universitario Ramón y Cajal, IRYCIS, Universidad de Alcalá, Alcalá de Henares, Madrid, Spain; Red de Oftalmología RETICS OFTARED del Instituto de Salud Carlos III (ISCIII), Madrid, Spain.
| | - A Antón
- Institut Català de la Retina (ICR), Barcelona, Spain; Universitat Internacional de Catalunya (UIC), Barcelona, Spain; Red de Oftalmología RETICS OFTARED del Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - M Pazos
- Institut Clínic d'Oftalmologia, Hospital Clínic de Barcelona, IDIBAPS, Universitat de Barcelona, Barcelona, Spain; Red de Oftalmología RETICS OFTARED del Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - I Rodriguez-Uña
- Instituto Oftalmológico Fernández-Vega, Universidad de Oviedo, Oviedo, Spain; Red de Oftalmología RETICS OFTARED del Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - I Rodriguez Agirretxe
- Servicio de Oftalmología, Hospital Universitario Donostia, San Sebastián, Gipuzkoa, Spain; Red de Oftalmología RETICS OFTARED del Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - J M Martinez de la Casa
- Servicio de Oftalmología, Hospital Clinico San Carlos, Instituto de investigación sanitaria del Hospital Clínico San Carlos (IsISSC), IIORC, Universidad Complutense de Madrid, Madrid, Spain; Red de Oftalmología RETICS OFTARED del Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - M E Ayala
- Institut Català de la Retina (ICR), Barcelona, Spain; Red de Oftalmología RETICS OFTARED del Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - M Parrilla-Vallejo
- Servicio de Oftalmología, Hospital Universitario Virgen Macarena, Sevilla, Spain; Red de Oftalmología RETICS OFTARED del Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - A Dyrda
- Institut Català de la Retina (ICR), Barcelona, Spain
| | - L Díez-Álvarez
- Servicio de Oftalmología, Hospital Universitario Ramón y Cajal, IRYCIS, Universidad de Alcalá, Alcalá de Henares, Madrid, Spain; Red de Oftalmología RETICS OFTARED del Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - G Rebolleda
- Servicio de Oftalmología, Hospital Universitario Ramón y Cajal, IRYCIS, Universidad de Alcalá, Alcalá de Henares, Madrid, Spain; Red de Oftalmología RETICS OFTARED del Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - F J Muñoz-Negrete
- Servicio de Oftalmología, Hospital Universitario Ramón y Cajal, IRYCIS, Universidad de Alcalá, Alcalá de Henares, Madrid, Spain; Red de Oftalmología RETICS OFTARED del Instituto de Salud Carlos III (ISCIII), Madrid, Spain
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Patel S, Reiss G. Long-Term Clinical and Safety Outcomes of Canaloplasty Performed across All Grades of Glaucoma Severity. J Ophthalmol 2023; 2023:5625990. [PMID: 37207241 PMCID: PMC10191748 DOI: 10.1155/2023/5625990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 03/13/2023] [Accepted: 04/24/2023] [Indexed: 05/21/2023] Open
Abstract
Purpose To investigate the clinical effectiveness of canaloplasty performed with an ab interno technique using the iTrack microcatheter (Nova Eye Medical) in patients with mild-moderate glaucoma as compared to severe glaucoma. Methods This is a retrospective single-center case series. Patients were preoperatively categorized as mild/moderate vs. severe glaucoma assessed using the mean deviation (MD) score and controlled group (baseline intraocular pressure (IOP) ≤18 mmHg) vs. uncontrolled group (>18 mmHg). All patients with glaucoma were eligible for recruitment except those who had undergone previous glaucoma surgery (with the exception of selective laser trabeculoplasty or SLT). Patients underwent canaloplasty via an ab interno surgical technique with or without phacoemulsification and were monitored for IOP, glaucoma medication usage, and surgical complications. Results In total, 72 eyes were followed for 3.4 ± 0.5 years. Mean pre-op IOP (mmHg) was 19.3 ± 7.7 in the standalone group (n = 9) and 18.5 ± 5.6 in the combined group (n = 63) (p=0.38). At the last follow-up, mean IOP reduced by 36% to 12.4 ± 4.4 (p=0.02) in the standalone group and by 26% to 13.7 ± 4.8 in the combined group (p < 0.001). Mean pre-op IOP (mmHg) was 18.6 ± 5.2 in the severe group (n = 24) and 18.6 ± 6.2 in the mild-moderate group (n = 48) (p=0.48). Mean IOP was 14.1 ± 6.3 (-24%; p < 0.001) and 13.3 ± 3.7 (-29%; p < 0.001), respectively, at the last follow-up. Mean glaucoma medication usage decreased from 2.5 ± 0.9 to 2.1 ± 0.9 (-15%; p=0.083) in the severe group and 2.3 ± 1.0 to 1.4 ± 1.3 (-40%; p < 0.001) in the mild/moderate group. There was one localized Descemet's membrane detachment in the moderate group. Conclusion iTrack canaloplasty achieved a statistically significant IOP reduction in mild-moderate and severe eyes and was found to be an effective option for reducing IOP and medications in patients with mild-moderate primary open-angle glaucoma (POAG). In severe eyes, it has reduced IOP while the medications remained stable.
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Affiliation(s)
- Shamil Patel
- Banner-University Medical Center Phoenix, Phoenix, USA
| | - George Reiss
- Banner-University Medical Center Phoenix, Phoenix, USA
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Fujita A, Sakata R, Hashimoto Y, Matsui H, Fushimi K, Yasunaga H, Aihara M. One-year costs of incisional glaucoma surgery and laser therapy. ANNALS OF CLINICAL EPIDEMIOLOGY 2022; 5:48-57. [PMID: 38505733 PMCID: PMC10944997 DOI: 10.37737/ace.23007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 10/04/2022] [Indexed: 03/21/2024]
Abstract
BACKGROUND This study aimed to calculate one-year total costs of incisional glaucoma surgery and laser therapy in a real-world clinical setting. METHODS We conducted a retrospective cohort study from July 2010 to March 2021 using the Diagnosis Procedure Combination database. We included patients hospitalized for incisional glaucoma surgery (trabeculectomy, trabeculotomy, tube shunt surgery, Ex-PRESS surgery, or iStent implantation) or laser therapy (laser peripheral iridotomy, surgical iridectomy, laser trabeculoplasty, cyclocryotherapy, or cyclophotocoagulation). The outcomes were total costs, including costs of hospitalization, re-admissions, antiglaucoma drugs, ophthalmic examinations, and outpatient visits for incisional glaucoma surgery and laser therapy within one year. RESULTS We identified 49,202 eligible hospitalizations. The one-year median total cost was 707,497 yen [interquartile range: 546,887-944,664 yen]. The median total cost was the highest in patients undergoing tube shunt surgery, followed by Ex-PRESS surgery, iStent implantation, and trabeculectomy. The number and cost of postoperative outpatient visits and length of hospital stay were higher in patients who underwent trabeculectomy and Ex-PRESS surgery than in those after tube shunt surgery. The total costs of laser therapies were lower than those of incisional glaucoma surgeries. The total cost was the highest in the 0-19 age group (856,398 [649,419-1,258,844] yen). CONCLUSIONS Tube shunt surgery was the costliest in terms of total one-year costs. Trabeculectomy and Ex-PRESS surgery were associated with long hospital stays and incurred high postoperative costs. The costs of laser therapies were relatively low. However, cost-effectiveness of laser therapies compared with incisional surgeries needs to be analyzed in future research.
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Affiliation(s)
- Asahi Fujita
- Department of Ophthalmology, Graduate School of Medicine, The University of Tokyo
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo
| | - Rei Sakata
- Department of Ophthalmology, Graduate School of Medicine, The University of Tokyo
| | - Yohei Hashimoto
- Department of Ophthalmology, Graduate School of Medicine, The University of Tokyo
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School of Medicine
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo
| | - Makoto Aihara
- Department of Ophthalmology, Graduate School of Medicine, The University of Tokyo
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Chen D, Guo XJ, Luo SK, Lu Y, Tang XR. Efficacy and safety of high-intensity focused ultrasound cyclo-plasty in glaucoma. BMC Ophthalmol 2022; 22:401. [PMID: 36207670 PMCID: PMC9542456 DOI: 10.1186/s12886-022-02622-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Accepted: 09/26/2022] [Indexed: 11/21/2022] Open
Abstract
Background High-intensity focused ultrasound cyclo-plasty (UCP) is a recently developed glaucoma surgery. This study collected and analysed the clinical data of patients who underwent UCP to observe the efficacy and safety of this surgery in Chinese glaucoma patients. Methods This was a retrospective study. The clinical data of all the patients who underwent UCP at Affiliated Foshan Hospital, Southern Medical University, were collected and analysed to evaluate the efficacy and safety of UCP. The main outcome measure was intraocular pressure, and the secondary outcome measures were best corrected visual acuity (logMAR) and complications. Results Fifty-eight patients (61 eyes) were recruited for this study. IOP was dramatically decreased during the 12 months after UCP (p<0.05). The median IOP reduction during the 18 months post-procedure was more than 30%. The greatest reduction was at 1 month post-UCP (60.86%). The qualified success rate was more than 60% during the 18-month follow-up (Fig. 1). Poor follow up was found after 6-month post-UCP. The highest success rate was obtained at 7 days post-UCP (94.55%). No statistically significant decrease in BCVA in the vison group was observed at the follow-up visits, except for 1 day post-UCP. There was a statistically significant reduction in the use of IOP lowering medications during the 6 months post-UCP. No severe complications occurred. Conclusion UCP is a safe and effective procedure for primary and refractive glaucoma at least during the 6 months post-UCP procedure. Studies with longer follow-up time and better follow up are needed to further confirm the long-term efficacy and safety of UCP in Chinese glaucoma patients. Supplementary Information The online version contains supplementary material available at 10.1186/s12886-022-02622-5.
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Affiliation(s)
- Di Chen
- Department of Ophthalmology, Affiliated Foshan Hospital, Southern Medical University, Foshan, 528000, China
| | - Xiu-Juan Guo
- Department of Ophthalmology, Affiliated Foshan Hospital, Southern Medical University, Foshan, 528000, China.
| | - Shu-Ke Luo
- Department of Ophthalmology, Affiliated Foshan Hospital, Southern Medical University, Foshan, 528000, China
| | - Yan Lu
- Department of Ophthalmology, Affiliated Foshan Hospital, Southern Medical University, Foshan, 528000, China
| | - Xiu-Rong Tang
- Department of Ophthalmology, Affiliated Foshan Hospital, Southern Medical University, Foshan, 528000, China
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Anton A, Garcia V, Muñoz M, Gonzales K, Ayala E, del Mar Sanchez E, Morilla-Grasa A. The Effect of Oral Citicoline and Docosahexaenoic Acid on the Visual Field of Patients with Glaucoma: A Randomized Trial. Life (Basel) 2022; 12:life12101481. [PMID: 36294916 PMCID: PMC9604833 DOI: 10.3390/life12101481] [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: 07/29/2022] [Revised: 09/08/2022] [Accepted: 09/16/2022] [Indexed: 11/16/2022] Open
Abstract
The role of nutraceuticals in the treatment of glaucoma remains controversial. The aim of this study was to evaluate the effect of citicoline, vitamin C, and docosahexaenoic acid (DHA) in patients with glaucoma. Methods: This was a prospective, randomized study. Patients with glaucoma were randomized to one of four groups and treated for 3 months with vitamin C, DHA, citicoline, or a combination of DHA and citicoline. We conducted a complete ophthalmic examination and visual fields each month and calculated the slopes of field indices. Changes in visual field indices (VFIs) and their slopes were assessed in each group and compared. Results: Seventy-three persons were included in the study. Mean defect (MD) significantly improved (p = 0.001) from −9.52 ± 4.36 to −7.85 ± 4.36 dB during the study period in persons taking DHA + citicoline. Similarly, the mean VFI significantly improved (p = 0.001) in this group. The only treatment group showing a statistically significant improvement (p = 0.006) in the MD (from −0.1041 ± 0.2471 to 0.1383 ± 0.2544 dB/month) and VFI slope was the group treated with DHA+citicoline. Conclusions: The combination of oral treatment with DHA + citicoline significantly improved VF indices and their slopes in patients with glaucoma after 3 months of treatment.
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Affiliation(s)
- Alfonso Anton
- Institut Catala de Retina, Universitat Internacional de Catalunya, 08017 Barcelona, Spain
- Correspondence: ; Tel.: +34-932531647 or +34-934340553
| | | | - Marcos Muñoz
- Institut Catala de Retina, Universitat Internacional de Catalunya, 08017 Barcelona, Spain
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Zhou Q. Meta-Analysis of the Comprehensive Efficacy of Intraocular Lens Implantation in Glaucoma Patients. BIOMED RESEARCH INTERNATIONAL 2022; 2022:5130416. [PMID: 36017382 PMCID: PMC9398797 DOI: 10.1155/2022/5130416] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 07/04/2022] [Accepted: 07/05/2022] [Indexed: 12/03/2022]
Abstract
This study is aimed at investigating the efficacy of intraocular lens (IOL) implantation in patients suffering from glaucoma through meta-analysis of the previously published research. For this purpose, different literature databases were searched for identification of clinical studies published between January 2000 and January 2022 on evaluating IOL's efficacy in treating glaucoma. RevMan 5.3 was used to conduct a meta-analysis of the pertinent data. The central anterior chamber depth (ACD), corneal endothelial cell counts, best-corrected visual acuity (BCVA), intraocular pressure (IOP), anti-glaucoma medications (AGM), and axial length (AL) changes were compared, and the incidence of postoperative complications was thoroughly evaluated. The Cochran chi-square test was used to examine the heterogeneity of the evaluation results. According to the inclusion and exclusion criteria, 20 studies included 948 glaucomatous eyes. IOP was significantly lower than before treatment (MD = 8.64, 95 CI: 5.75-11.53; Z = 5.86, P < 0.0001), while ACD increased significantly (MD = -1.38, 95 percent CI: -1.74-1.02; Z = 7.49, P < 0.0001). The corneal endothelial cell counts were homogeneous (MD = 225.08, 95% CI: -64.17 to -514.33; Z = 1.53, P = 0.20). AGM utilisation decreased (MD = 1.43, 95% CI: 0.752.12, Z = 4.09, P < 0.0001). AL decreased significantly (MD = 0.31; 95% CI: 0.09-0.54; Z = 2.71; P = 0.007). The incidence of complications remained insignificant after IOL treatment (OR = 1.05, 95% CI: 0.42 to 2.60; Z = 0.10, P = 0.92; P = 0.92). These findings indicate that IOL treatment can significantly reduce intraocular pressure, glaucoma drug use, and aqueous level (AL) in glaucoma patients while increasing the depth of the central anterior chamber. This study offers a theoretical foundation for selecting glaucoma treatment methods.
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Affiliation(s)
- Qingyi Zhou
- Department of Ophthalmology. Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, 158 Shangtang Road, Hangzhou, 310014 Zhejiang, China
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Nikhalashree S, George R, Shantha B, Vijaya L, Sulochana KN, Coral K. Anti-glaucoma medications lowered decorin and altered profibrotic proteins in human tenon's fibroblasts. Exp Eye Res 2022; 224:109199. [PMID: 35878659 DOI: 10.1016/j.exer.2022.109199] [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: 11/29/2021] [Revised: 06/19/2022] [Accepted: 07/18/2022] [Indexed: 11/04/2022]
Abstract
Long term exposure to anti-glaucoma medications (AGMs) leads to an increase in extracellular matrix (ECM) accumulation in primary glaucoma patients. This study aims to evaluate the effect of topical AGMs in primary human tenon's fibroblasts (HTFs) and analyze the expression of profibrotic and anti-fibrotic proteins. Primary HTFs were cultured from patients undergoing cataract (control) and trabeculectomy. The different types of AGMs in single/multiple combinations (BB, PG, AA, CAI, CH, combinations of 3- PG + AA + CAI, 4A- BB + PG + AA + CAI, 4B- BB + PG + CAI + CH and 5- BB + PG + AA + CAI + CH) on chronic exposure were tested for cell viability using MTT assay and morphological alterations. Profibrotic proteins mainly SPARC, LOXL2, COL1A1 and anti-fibrotic DCN were analyzed in treated HTFs using q-PCR and ELISA. Sirius red staining and collagen gel contraction (CGC) assay were performed to assess collagen synthesis and the contractility of HTFs, respectively. Except for AA and CH, the other AGMs at a higher concentration were found to decrease the cell viability of HTFs. The morphology of HTFs were altered on exposure to BB, CH and AA; Profibrotic proteins i.e., SPARC, LOXL2 and COL1A1 were significantly increased (p < 0.05) on exposure to a combination of AGMs with TGF-β1, whereas the anti-fibrotic DCN expression was significantly lowered (p < 0.05) in single/multiple AGM exposure. Sirius red staining showed increased collagen synthesis with combinations of AGMs with TGF-β1. Meanwhile, HTFs showed increased collagen gel contraction with TGF-β1, CAI and CH. This study reveals that altered profibrotic proteins, with significantly lowered DCN on chronic exposure of AGMs in HTFs.
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Affiliation(s)
- Sampath Nikhalashree
- R.S. Mehta Jain Department of Biochemistry and Cell Biology, KBIRVO Block, Vision Research Foundation, Sankara Nethralaya, Chennai, India; School of Chemical and Biotechnology, SASTRA Deemed-to-be University, Thanjavur, India
| | - Ronnie George
- Smt Jadhavbai Nathmal Singhvee Glaucoma Services, Medical Research Foundation, Sankara Nethralaya, Chennai, India
| | - Balekudaru Shantha
- Smt Jadhavbai Nathmal Singhvee Glaucoma Services, Medical Research Foundation, Sankara Nethralaya, Chennai, India
| | - Lingam Vijaya
- Smt Jadhavbai Nathmal Singhvee Glaucoma Services, Medical Research Foundation, Sankara Nethralaya, Chennai, India
| | | | - Karunakaran Coral
- R.S. Mehta Jain Department of Biochemistry and Cell Biology, KBIRVO Block, Vision Research Foundation, Sankara Nethralaya, Chennai, India.
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Outcomes of Anterior Chamber, Sulcus, and Pars Plana Glaucoma Drainage Device Placement in Glaucoma Patients. J Ophthalmol 2022; 2022:5947992. [PMID: 35909463 PMCID: PMC9328986 DOI: 10.1155/2022/5947992] [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: 03/16/2022] [Accepted: 07/01/2022] [Indexed: 12/01/2022] Open
Abstract
Purpose To assess outcomes of anterior chamber (AC), sulcus, and pars plana (PP) glaucoma drainage device (GDD) placement in glaucoma patients. Patients and Methods. Retrospective evaluation of glaucoma patients who underwent GDD insertion in the AC, sulcus, or PP at Massachusetts Eye and Ear between November 2016 and May 2021. Patients who received AC, sulcus, and pars plana tubes were selected using simple random sampling, and the first 40 patients meeting inclusion criteria were analyzed. Main outcome measures were cumulative success probabilities from Kaplan-Meier (KM) analyses, intraocular pressure (IOP), medication burden, and complication rates. Results The PP group had a larger proportion of Ahmed GDDs and was younger on average with less severe glaucoma compared to patients with AC or sulcus tubes. The PP group had a higher proportion of mixed-mechanism glaucoma and lower proportion of primary open-angle glaucoma. With success defined as IOP reduction ≥20% and 5 < IOP ≤ 21 mm Hg, the Kaplan-Meier cumulative success probabilities for all three GDD locations were not significantly different. No significant differences were found in complication rates between all groups after 3 months. Patients with PP GDD had significantly lower medication burden than those with AC or sulcus GDDs up to 1.5 years postoperatively (1.7 ± 1.1, 3.0 ± 1.4, and 2.8 ± 1.2 for PP, AC, and sulcus, respectively; P=0.017). Conclusion PP GDDs may be more effective in lowering medication burden than AC or sulcus tubes without compromising long-term safety.
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COMPARISON OF THE EFFICIENCY OF NON-PENETRATING DEEP SCLERECTOMY AS A STANDALONE SURGERY AND MODIFIED NON-PENETRATING DEEP SCLERECTOMY IN COMBINATION WITH AB INTERNO ENDOTRABECULECTOMY. ACTA MEDICA LEOPOLIENSIA 2022. [DOI: 10.25040/aml2022.1-2.118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Aim. To compare the hypotensive effect of non-penetrating deep sclerectomy (NPDS) as a standalone surgery and non-penetrating deep sclerectomy in combination with dosed endotrabeculectomy in patients with primary open-angle glaucoma.
Materials and Methods. 27 patients (27 eyes) with primary open-angle glaucoma were under our follow-up. In the first group (15 patients) we performed a non-penetrating deep sclerectomy, in the second group (12 patients) - a combined surgery.
Results and Discussion. When comparing values, we found that the difference between the preoperative and postoperative IOP, as well as the preoperative and postoperative amount of topical antihypertensives used, was significant up to the 12th month inclusive in both groups (p<0.05). No significant difference was found when comparing IOP values between two groups in the same follow-up periods. However, there was a difference in the amount of topical intraocular pressure-lowering agents used by two groups in the 12th month of follow-up.
Conclusions. Non-penetrating deep sclerectomy, both standalone and in combination with endotrabeculectomy, has a significant hypotensive effect in patients with primary open-angle glaucoma during 12 months of follow-up, however, patients of the first group instilled a higher amount of topical antihypertensives in the 12th month of follow-up, which makes us consider the hypotensive effect of the combined surgery to be higher.
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YAP/TAZ Promote Fibrotic Activity in Human Trabecular Meshwork Cells by Sensing Cytoskeleton Structure Alternation. CHEMOSENSORS 2022. [DOI: 10.3390/chemosensors10070235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Trabecular meshwork (TM) is the main channel of aqueous humor (AH) outflow and the crucial tissue responsible for intraocular pressure (IOP) regulation. The aberrant fibrotic activity of human TM (HTM) cells is thought to be partially responsible for the increased resistance to AH outflow and elevated IOP. This study aimed to identify the TM cell fibrotic activity biomarker and illustrate the mechanisms of fibrotic activity regulation in HTM cells. We used TGFβ2-treated HTM cells and detected the changes in the cytoskeletal structure, the Yes-associated protein (YAP) and its transcriptional co-activator with PDZ-binding domain (TAZ) activation, and the expression levels of the fibrosis-related proteins Collagen I and α-SMA in HTM cells by immunofluorescence staining or western bolt analyses. The expression of YAP was inhibited using siRNA transfection. The results showed that the expression levels of YAP/TAZ and the fibrosis-related proteins Collagen I and α-SMA in HTM cells were elevated under TGF-β2 treatment, which was correlated with the structural change of the cellular F-actin cytoskeleton. Furthermore, the inhibition of YAP decreased the expression of connective tissue growth factor (CTGF), Collagen I, and α-SMA in HTM cells. These findings demonstrate that YAP/TAZ are potential biomarkers in evaluating the TM cell fibrotic activity, and it could sense cytoskeletal structure cues and regulate the fibrotic activity of TM cells.
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Man REK, Fenwick EK, Khadka J, Wu Z, Skalicky S, Pesudovs K, Lamoureux EL. Psychometric Evaluation of Glaucoma Quality of Life Item Banks (GlauCAT) and Initial Assessment Using Computerized Adaptive Testing. Transl Vis Sci Technol 2022; 11:9. [PMID: 35679035 PMCID: PMC9187937 DOI: 10.1167/tvst.11.6.9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 05/18/2022] [Indexed: 11/24/2022] Open
Abstract
Purpose To evaluate the psychometric properties of glaucoma-specific quality of life (QoL) item banks (GlauCAT) and assess their performance using computerized adaptive testing (CAT) simulations. Methods In this cross-sectional study, 293 participants with glaucoma (mean age ± SD, 70.7 ± 13.2 years; 45% female) answered 342 items in 12 QoL item banks (IBs): Activity Limitation (AL); Driving (DV); Convenience (CV); Economic (EC); Emotional (EM); General Symptoms (GS); Health Concerns (HC); Lighting (LT); Mobility (MB); Ocular Surface Symptoms (OS); Social (SC); and Visual Symptoms (VS). These IBs were assessed using Rasch analysis, and CAT simulations with 1000 simulated respondents were utilized to determine the average number of items to be administered to achieve moderate and high precision levels. Results The AL, DV, EM, HC, LT, MB, EC, OS, SC, and VS IBs required relatively minor amendments to achieve satisfactory psychometric fit. To resolve multidimensionality, we split CV into Treatment Convenience (TCV) and General Convenience (GCV). Due to poor measurement precision, the GS IB was not pursued further. This resulted in 12 total IBs. In CAT simulations, an average of 3.7 and 7.3 items per IB were required to attain measurement at moderate and high precision, respectively. Conclusions Following rigorous psychometric assessment, we developed 12 valid glaucoma-specific QoL domains that can obtain highly precise person measure estimates using a small number of items. Translational Relevance GlauCAT will enable researchers and clinicians to quickly and comprehensively assess the impact of glaucoma and its associated interventions across a range of QoL domains.
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Affiliation(s)
- Ryan Eyn Kidd Man
- Singapore Eye Research Institute and Singapore National Eye Centre, Singapore
- Duke–NUS Medical School, National University of Singapore, Singapore
| | - Eva K. Fenwick
- Singapore Eye Research Institute and Singapore National Eye Centre, Singapore
- Duke–NUS Medical School, National University of Singapore, Singapore
| | - Jyoti Khadka
- Health and Social Care Economics Group, College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
- Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- Business School, University of South Australia, Adelaide, South Australia, Australia
| | - ZhiChao Wu
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia
- Ophthalmology, Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia
| | - Simon Skalicky
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia
- Ophthalmology, Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
| | - Konrad Pesudovs
- School of Optometry and Vision Science, University of New South Wales, Sydney, New South Wales, Australia
| | - Ecosse L. Lamoureux
- Singapore Eye Research Institute and Singapore National Eye Centre, Singapore
- Duke–NUS Medical School, National University of Singapore, Singapore
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia
- Ophthalmology, Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia
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Brinzolamide-loaded soft contact lens for ophthalmic delivery. Ther Deliv 2022; 13:233-247. [PMID: 35615865 DOI: 10.4155/tde-2022-0005] [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] Open
Abstract
Aim: In this study, brinzolamide (BRZ) was loaded in balafilcon A silicone hydrogel soft contact lens to enhance delivery in glaucoma therapy. Materials & methods: BRZ-loaded soft contact lens was prepared by the soaking method with optimization of pH, temperature and concentration of drug loading solution. Results: At pH 7.4, loading temperature and concentration of 32°C and 3 mg/ml, respectively, enhanced drug loading capacity and release were observed. Diffusional experiments showed Higuchi model of release. BRZ loading brought no appreciable changes in the physical properties of soft contact lens, likewise, maintaining stability. Conclusion: The results demonstrated BRZ loading and delivery through silicone hydrogel soft contact lens which provides a potential alternative in glaucoma therapy.
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Bambo MM, Gebremariam MG. Statistical Analysis on Time to Blindness of Glaucoma Patients at Jimma University Specialized Hospital: Application of Accelerated Failure Time Model. J Ophthalmol 2022; 2022:9145921. [PMID: 35607611 PMCID: PMC9124144 DOI: 10.1155/2022/9145921] [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: 02/18/2022] [Revised: 03/30/2022] [Accepted: 04/23/2022] [Indexed: 11/17/2022] Open
Abstract
Background Glaucoma is one of the most frequent vision-threatening eye diseases. It is frequently associated with excessive intraocular pressure (IOP), which can cause vision loss and damaged optic nerves. The main objective of this study was to model time to blindness of glaucoma patients by using appropriate statistical models. Study Design. A Retrospective Community-Based Longitudinal Study design was applied. Materials and Procedures. The data were obtained from Ophthalmology Department of JUSH from the period of January 2016 to August 2020. The glaucoma patient's information was extracted from the patient card and 321 samples were included in the study. To discover the factors that affect time to blindness of glaucoma patients', researchers used the Accelerated Failure Time (AFT) model. Results 81.3 percent of the 321 glaucoma patients were blind. Unilaterally and bilaterally blinded female and male glaucoma patients were 24.92 and 56.38%, respectively. After glaucoma disease was confirmed, the median time to the blindness of both eyes and one eye was 12 months. The multivariable log-logistic accelerated failure-time model fits the glaucoma patient's time to blind dataset well. The result showed that the chance of blindness of glaucoma patients who have absolute stage of glaucoma, medium duration of diagnosis, long duration of diagnosis, and IOP greater than 21 mmHg were high with parameters (ϕ = 2.425, p value = 0.049, 95% CI [2.249, 2.601]), (ϕ = 1.505, p value = 0.001, 95% CI [0.228, 0.589]), (ϕ = 3.037, p value = 0.001, 95% C.I [2.850, 3.22]) and (ϕ 0.851, p value = 0.034, 95% C.I [0.702, 0.999]), respectively. Conclusion The multivariable log-logistic accelerated failure time model evaluates the prognostic factors of time to blindness of glaucoma patients. Under this finding, duration of diagnosis, IOP, and stage of glaucoma were a key determinant factors of time to blindness of glaucoma patients'. Finally, the log-logistic accelerated failure-time model was the best-fitted parametric model based on AIC and BIC values.
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Affiliation(s)
- Meseret Mesfin Bambo
- Department of Statistics, College of Natural and Computational Science, Mizan-Tepi University, Tepi, Ethiopia
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Bisorca-Gassendorf L, Murovski S, Julich-Härtel H, Rickmann A, Szabo JE, Erokhina M, Wenzel M, Januschowski K. Asynchronous Teleophthalmology for Monitoring Glaucoma Patients in a Rural German Region: A Retrospective Observational Pilot Study. Cureus 2022; 14:e24210. [PMID: 35602839 PMCID: PMC9117824 DOI: 10.7759/cureus.24210] [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] [Accepted: 04/17/2022] [Indexed: 11/13/2022] Open
Abstract
Background: Coronavirus disease 2019 (COVID-19) has created an escalating need for limiting in-person examination and potential viral exposure. Under these circumstances, teleophthalmology allows ophthalmologists to continue providing care to patients while ensuring their safety and that of the medical staff. Objective: The primary objective of this study was to assess patient satisfaction with an asynchronous teleconsultation for glaucoma patients in a rural German area. Secondary endpoints were patient adherence and the need to change the therapeutic regime. Methods: This retrospective, observational, and monocentric study included 50 patients diagnosed with primary open-angle glaucoma (n = 49) and ocular hypertension (n = 1) requiring medication to lower intraocular pressure (IOP). Only patients with well-controlled diseases were included, and a brief questionnaire was evaluated, which was completed one year after the baseline visit. Best-corrected visual acuity (BCVA), IOP measurements, visual fields, optical coherence tomography images of the optic nerve head, ultra-widefield photographs of the fundus, and photographs of the anterior segment of the eye were taken at each visit by an experienced optometrist. Results: Of the 50 patients included, the mean number of follow-up visits in this observation period was 4.4. No patient was lost to follow-up, and there were a total of nine missed follow-up visits (but not lost to follow-up). No patients required a change in their treatment regime during the observational period. Regarding patient-focused assessment, the majority of patients were satisfied or very satisfied with teleconsultation in general. Conclusion: Asynchronous teleophthalmology is a promising option and effective means to monitor glaucoma patients. The majority of teleophthalmology patients were satisfied with their teleconsultation and adhered to the follow-up schedule. However, prospective trials with a larger number of patients and a more focused examination on specific patient populations are required. Further trials should also focus on the aspect of cost-effectiveness.
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Paul C, Divya J, Kamal R, Paul A. Ologen implant versus mitomycin C in combined trabeculectomy and phacoemulsification. Indian J Ophthalmol 2022; 70:1248-1252. [PMID: 35326026 PMCID: PMC9240563 DOI: 10.4103/ijo.ijo_2027_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Purpose: To comparatively evaluate in Indian eyes with coexisting cataract and primary open-angle glaucoma the outcome of mitomycin C (MMC) and Ologen implant as adjunctives in combined phacoemulsification with trabeculectomy. Methods: Eyes with primary open-angle glaucoma that underwent trabeculectomy and phacoemulsification with IOL implantation with either MMC application or Ologen implant between June 2019 and February 2020 were followed up for 12 months. Thirty-four eyes of 34 participants were studied. The primary outcome was intraocular pressure (IOP), and the secondary outcomes were the number of ocular hypotensives, best distance visual acuity (BDVA), and bleb morphology. Results: In 16 eyes treated with MMC and 18 eyes treated with Ologen implant, it was observed that the mean postoperative IOP (14.62 ± 2.89 mm Hg with MMC and 14.56 ± 4.14 mm Hg with Ologen implant) was not significantly different in both groups (P = 0.47). Number of ocular hypotensives and BDVA were also comparable between the two groups. However, bleb morphology was better with Ologen implantation. One eye in the MMC group developed hypotony which was conservatively managed Conclusion: MMC and Ologen are both effective adjunctives in combined phaco-trabeculectomy. However, the Ologen implant provides better bleb health and safety.
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Affiliation(s)
- Chandrima Paul
- Glaucoma Services, Director; B B Eye Foundation, Kolkata, West Bengal, India
| | - J Divya
- Comprehensive Ophthalmology; B B Eye Foundation, Kolkata, West Bengal, India
| | - Richa Kamal
- Vitreo-Retinal Surgery; B B Eye Foundation, Kolkata, West Bengal, India
| | - Anujeet Paul
- Department of Ophthalmology, Mahatma Gandhi Medical College and Research Institute, Pondicherry, India
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Shang Q, Yang Y, Li H. LINC01605 knockdown induces apoptosis in human Tenon's capsule fibroblasts by inhibiting autophagy. Exp Ther Med 2022; 23:343. [PMID: 35401799 PMCID: PMC8988162 DOI: 10.3892/etm.2022.11273] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 01/25/2022] [Indexed: 11/06/2022] Open
Abstract
Glaucoma is an irreversible disease that causes blindness. Formation of a hypertrophic scar (HS) is the main cause of failure of glaucoma surgery. The long non-coding RNA LINC01605 is closely associated with the formation of HS; however, the function of LINC01605 in the formation and development of HS remains unclear. For this study, firstly, human Tenon's capsule fibroblasts (HTFs) and corneal epithelial cells (control cells) were collected from patients (n=5) with POAG who underwent glaucoma filtration surgery at Fuyang People's Hospital. Immunofluorescence analysis was performed to detect the expression levels of vimentin (one of the main components of medium fiber and plays an important role in the cytoskeleton and motility), keratin (the main component of cytoskeletal proteins) and LC3 (an autophagy marker). In addition, reverse transcription-quantitative PCR analysis was performed to detect LINC01605 expression. Besides, the Cell Counting Kit-8 assay was performed to assess the viability of human Tenon's capsule fibroblasts (HTFs). Next, flow cytometry was performed to detect HTF apoptosis. Furthermore, western blot analysis was performed for Bax, Bcl-2, Pro-caspase-3, cleaved caspase-3, phosphorylated (p-)Smad2, Smad2, α-SMA, MMP9, ATG7, p62, beclin 1, p-AMPK and AMPK in HTFs to determine the mechanism by which LINC01605 regulates the formation and development of HS. Moreover, a Transwell assay was performed to detect the migratory ability of HTFs. The results demonstrated that LINC01605 was significantly upregulated in HS tissues compared with that in normal (control/healthy) tissues. In addition, vimentin was highly expressed in HTFs, whereas keratin was expressed at a low level. Also, in HTFs, LINC01605 knockdown inhibited cell viability by inducing apoptosis, decreasing Smad2 activation and inhibiting autophagy. Furthermore, LINC01605 knockdown significantly inhibited the migratory ability of HTFs. Transfection with LINC01605 small interference RNAs significantly downregulated the expression levels of p-Smad2, α-SMA and MMP9 in HTFs. Furthermore, LINC01605 knockdown notably inhibited the viability and migration, and induced the apoptosis of HTFs, the effects of which were reversed following treatment with TGF-β. Taken together, the results of the present study suggested that LINC01605 knockdown may inhibit the viability of HTFs by inducing the apoptotic pathway. These findings may provide novel directions for the treatment of HS.
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Affiliation(s)
- Qifei Shang
- Department of Ophthalmology, Fuyang People's Hospital, Hangzhou, Zhejiang 311400, P.R. China
| | - Yanhua Yang
- Department of Ophthalmology, Fuyang People's Hospital, Hangzhou, Zhejiang 311400, P.R. China
| | - Hangzhu Li
- Department of Ophthalmology, Fuyang People's Hospital, Hangzhou, Zhejiang 311400, P.R. China
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Suzuki Y, Kiyosawa M. Cardiac Hypertrophy May Be a Risk Factor for the Development and Severity of Glaucoma. Biomedicines 2022; 10:biomedicines10030677. [PMID: 35327479 PMCID: PMC8945816 DOI: 10.3390/biomedicines10030677] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Revised: 03/09/2022] [Accepted: 03/13/2022] [Indexed: 02/05/2023] Open
Abstract
The purpose of this study was to examine the relationship between glaucoma and cardiac abnormalities. We evaluated 581 patients with open-angle glaucoma (285 men and 296 women) and 595 individuals without glaucoma (273 men and 322 women). All of the participants underwent visual field testing using a Humphrey Visual Field Analyzer (30-2 program), an electrocardiogram (ECG), and blood pressure measurement. We examined the ECG abnormalities and other factors (age, intraocular pressure (IOP) and systemic hypertension) involved in the development and severity of glaucoma. Logistic regression analyses revealed significant correlations of glaucoma with IOP (OR = 1.43; 95% CI: 1.36−1.51; p < 0.00001), atrial fibrillation (OR = 2.02; 95% CI: 1.01−4.04; p = 0.04), left ventricular hypertrophy (LVH) (OR = 2.21; 95% CI: 1.15−4.25; p = 0.02), and bradycardia (OR = 2.19; 95% CI: 1.25−4.70; p = 0.02). Regression analyses revealed significant correlations of the mean deviation of the visual field with age (t = −6.22; 95% CI: −0.15, −0.08; p < 0.00001), IOP (t = −6.47; 95% CI: −0.42, −0.23; p < 0.00001), and LVH (t = −2.15; 95% CI: −3.36, −0.29; p = 0.02). Atrial fibrillation, LVH and bradycardia may decrease the cerebral blood flow, and may also affect the ocular blood flow. Cardiac abnormalities may be associated with the development and severity of glaucoma.
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Affiliation(s)
- Yukihisa Suzuki
- Department of Ophthalmology, Japan Community Health Care Organization, Mishima General Hospital, Shizuoka 411-0801, Japan
- Research Team for Neuroimaging, Tokyo Metropolitan Institute of Gerontology, Tokyo 173-0015, Japan
- Correspondence: ; Tel.: +81-55-975-3031; Fax: +81-55-973-3647
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Chen G, Peng X, Li J, Chen P, Wang J. Efficacy of brinzolamide in the initial management of acute primary angle closure: A randomized controlled trial. J Clin Pharm Ther 2022; 47:792-797. [PMID: 35026861 DOI: 10.1111/jcpt.13609] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 12/28/2021] [Accepted: 01/04/2022] [Indexed: 11/30/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE?: Since comprehensive medication has an important role in the initial management of patients presenting with acute primary angle closure, it is necessary to analyse the effect of each drug on alleviating the disease. This study aimed to evaluate the intraocular pressure-lowering effect of brinzolamide in the sequential treatment of acute primary angle closure. METHODS: In this randomized double-blind controlled trial, a total of 131 eyes of 125 consecutive patients who presented with their first episode of acute primary angle closure were recruited and received sequential treatment. In this treatment, in the absence of remission, anti-glaucoma drugs, anterior chamber paracentesis and argon laser peripheral iridoplasty are used sequentially. The patients were randomized to receive either brinzolamide or normal saline as a placebo. The primary outcomes were decreased intraocular pressure, success rate and treatment time. RESULTS AND DISCUSSION: There was no statistically significant difference in the decreased level of intraocular pressure between the two groups at 6, 12 or 24 h after the start of treatment (p-values were 0.526, 0.206 and 0.130 respectively). The success rate and treatment time were also not significantly different between the groups. No adverse side effects of brinzolamide were observed in the brinzolamide group. WHAT IS NEW AND CONCLUSION?: In patients with a first episode of acute primary angle closure, brinzolamide did not improve the effectiveness of the sequential treatment for reducing the intraocular pressure levels or shortening the treatment time within the first 24 h of initiating therapy.
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Affiliation(s)
- Guang Chen
- Department of ophthalmology, Affiliated Hospital of Hebei University, Baoding, China
| | - Xinming Peng
- Department of ophthalmology, Affiliated Hospital of Hebei University, Baoding, China
| | - Jun Li
- Department of ophthalmology, Affiliated Hospital of Hebei University, Baoding, China
| | - Peng Chen
- Department of ophthalmology, Affiliated Hospital of Hebei University, Baoding, China
| | - Jing Wang
- Department of ophthalmology, Affiliated Hospital of Hebei University, Baoding, China
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