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Angmo D, Warjri GB, Gowtham L, Velpandian T, Dada T. Endocannabinoids and cortisol in plasma, aqueous and tear samples of primary angle closure glaucoma versus controls. Eur J Ophthalmol 2024:11206721241247419. [PMID: 38613316 DOI: 10.1177/11206721241247419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2024]
Abstract
PURPOSE To compare the levels of endocannabinoids (EC) in plasma, aqueous humor and tears, cortisol in plasma and aqueous, in primary angle closure glaucoma (PACG) and controls, while comparing the quality of life in both groups. METHODS A total of 60 patients, ≥40years of age, with a diagnosis of PACG or cataract, 30 in each group were recruited. They were subjected to a detailed ophthalmic evaluation, a WHO Quality of Life Brief Version (WHOQOL-BREF) questionnaire answering and collection of tear, aqueous and blood samples. The levels of endocannabinoids-anandamide (AEA), 2-arachidonoylglycerol (2AG) in plasma, aqueous humor and tears; cortisol in plasma and aqueous humor; and WHO-QOL score in each group were noted. RESULTS Plasma AEA (p = 0.01) and plasma 2-AG, (p = 0.002) levels were significantly higher in the control group as compared to the PACG group. WHO-QOL score was better in controls (p < 0.001). The EC were in undetectable levels in aqueous. Plasma and aqueous cortisol were significantly higher in PACG and both had the highest Area under the receiver operating characteristics (AUROC) curve value for differentiating PACG from controls. Tear 2AG and tear AEA had a moderately strong positive correlation with plasma 2-AG. Females had insignificantly higher levels of plasma and tear endocannabinoids. CONCLUSIONS Tear endocannabinoids were determined for the first time in PACG and normal with no difference between the two groups. Plasma and aqueous cortisol levels are a differentiating factor between normal and glaucoma patients with plasma endocannabinoids being remarkably higher in normals. Quality of life in glaucoma patients with high cortisol levels is poorer.
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Affiliation(s)
- Dewang Angmo
- Glaucoma Research Facility and Clinical Services, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Gazella Bruce Warjri
- Glaucoma Research Facility and Clinical Services, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - L Gowtham
- Ocular Pharmacology, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Thirumurthy Velpandian
- Ocular Pharmacology, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Tanuj Dada
- Glaucoma Research Facility and Clinical Services, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
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Lu PT, Tsai TH, Lai CC, Chuang LH, Shao SC. Validation of Diagnostic Codes to Identify Glaucoma in Taiwan's Claims Data: A Multi-Institutional Study. Clin Epidemiol 2024; 16:227-234. [PMID: 38586480 PMCID: PMC10999195 DOI: 10.2147/clep.s443872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 02/08/2024] [Indexed: 04/09/2024] Open
Abstract
Background Healthcare databases play a crucial role in improving our understanding of glaucoma epidemiology, which is the leading cause of irreversible blindness globally. However, the accuracy of diagnostic codes used in these databases to detect glaucoma is still uncertain. Aim To assess the accuracy of ICD-9-CM and ICD-10-CM codes in identifying patients with glaucoma, including two distinct subtypes, primary open-angle glaucoma (POAG) and primary angle-closure glaucoma (PACG). Methods We analyzed electronic medical records data from a 2% random sample of patients who newly underwent visual field examination in Taiwan's largest multi-institutional healthcare system from 2011 to 2020. The diagnosis of glaucoma was confirmed by two ophthalmologists, based on the glaucoma diagnostic criteria. The positive predictive value (PPV), negative predictive value (NPV), sensitivity and specificity for ICD-9-CM codes 365.1X and 365.2X, and ICD-10-CM codes H4010X, H4011X, H4012X, H4020X, H4021X, H4022X, H4023X and H4024X for glaucoma were calculated. Results We randomly selected 821 patients (mean age: 56.9 years old; female: 50.5%) from the original cohort of 41,050 newly receiving visual field examination in the study. Among 464 cases with an ICD-9-CM glaucoma code, the sensitivity, specificity, PPV and NPV for glaucoma were 86.5, 96.5, 91.9, and 90.9%, respectively. Among 357 cases with an ICD-10-CM glaucoma code, the sensitivity, specificity, PPV and NPV for glaucoma were 87.0, 92.8, 92.2 and 87.9%, respectively. The accuracy of diagnostic codes to identify POAG and PACG remained consistent. Conclusion The diagnostic codes were highly reliable for identifying cases of glaucoma in Taiwan's routine healthcare practice. These results provide confidence when using ICD-9-CM and ICD-10-CM codes to define glaucoma cases in healthcare database research in Taiwan.
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Affiliation(s)
- Pei-Ting Lu
- Department of Ophthalmology, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Tsung-Hsien Tsai
- Department of Ophthalmology, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Chi-Chun Lai
- Department of Ophthalmology, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Lan-Hsin Chuang
- Department of Ophthalmology, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Shih-Chieh Shao
- Department of Pharmacy, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan
- School of Pharmacy, Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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Shah SN, Zhou S, Sanvicente C, Burkemper B, Apolo G, Li C, Li S, Liu L, Lum F, Moghimi S, Xu B. Prevalence and Risk Factors of Blindness Among Primary Angle Closure Glaucoma Patients in the United States: An IRIS Registry Analysis. Am J Ophthalmol 2024; 259:131-140. [PMID: 37944688 PMCID: PMC10922147 DOI: 10.1016/j.ajo.2023.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 11/03/2023] [Accepted: 11/03/2023] [Indexed: 11/12/2023]
Abstract
PURPOSE To assess the prevalence and risk factors of blindness among patients newly diagnosed with primary angle closure glaucoma (PACG) in the United States. DESIGN Retrospective cross-sectional study. METHODS Eligible patients from the American Academy of Ophthalmology (AAO) Intelligent Research in Sight (IRIS) Registry had newly diagnosed PACG, defined as: 1) observable during a 24-month lookback period from index date of PACG diagnosis; 2) no history of eye drops, laser, or cataract surgery unless preceded by a diagnosis of anatomical narrow angle (ANA); and 3) no history of glaucoma surgery. Logistic regression models were developed to identify risk factors for any (one or both eyes) or bilateral (both eyes) blindness (visual acuity ≤20/200) at first diagnosis of PACG. RESULTS Among 43,901 eligible patients, overall prevalence of any and bilateral blindness were 11.5% and 1.8%, respectively. Black and Hispanic patients were at higher risk of any (odds ratios [ORs] 1.42 and 1.21, respectively; P < .001) and bilateral (ORs 2.04 and 1.53, respectively; P < .001) blindness compared with non-Hispanic White patients adjusted for ocular comorbidities. Age <50 or >80 years, male sex, Medicaid or Medicare insurance product, and Southern or Western practice region also conferred a higher risk of blindness (OR > 1.28; P ≤ .01). CONCLUSIONS Blindness affects 1 of 9 patients with newly diagnosed PACG in the IRIS Registry. Black and Hispanic patients and Medicaid and Medicare recipients are at significantly higher risk. These findings highlight the severe ocular morbidity among patients with PACG and the need for improved disease awareness and detection methods.
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Affiliation(s)
- Sona N Shah
- From the Roski Eye Institute (S.N.S., S.Z., B.B., G.A., B.X.), Department of Ophthalmology, University of Southern California, Los Angeles, California, USA
| | - Sarah Zhou
- From the Roski Eye Institute (S.N.S., S.Z., B.B., G.A., B.X.), Department of Ophthalmology, University of Southern California, Los Angeles, California, USA
| | - Carina Sanvicente
- Harvey & Bernice Jones Eye Institute (C.S.), University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Bruce Burkemper
- From the Roski Eye Institute (S.N.S., S.Z., B.B., G.A., B.X.), Department of Ophthalmology, University of Southern California, Los Angeles, California, USA
| | - Galo Apolo
- From the Roski Eye Institute (S.N.S., S.Z., B.B., G.A., B.X.), Department of Ophthalmology, University of Southern California, Los Angeles, California, USA
| | - Charles Li
- American Academy of Ophthalmology (C.L., S.L., L.L., F.L.), San Francisco, California, USA
| | - Siying Li
- American Academy of Ophthalmology (C.L., S.L., L.L., F.L.), San Francisco, California, USA
| | - Lynn Liu
- American Academy of Ophthalmology (C.L., S.L., L.L., F.L.), San Francisco, California, USA
| | - Flora Lum
- American Academy of Ophthalmology (C.L., S.L., L.L., F.L.), San Francisco, California, USA
| | - Sasan Moghimi
- Hamilton Glaucoma Center (S.M.), Shiley Eye Institute, Department of Ophthalmology, University of California, San Diego, La Jolla, California, USA
| | - Benjamin Xu
- From the Roski Eye Institute (S.N.S., S.Z., B.B., G.A., B.X.), Department of Ophthalmology, University of Southern California, Los Angeles, California, USA.
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Li S, Ren J, Jiang Z, Qiu Y, Shao M, Li Y, Wu J, Song Y, Sun X, Gao S, Cao W. Metabolomics identifies and validates serum androstenedione as novel biomarker for diagnosing primary angle closure glaucoma and predicting the visual field progression. eLife 2024; 12:RP91407. [PMID: 38358793 PMCID: PMC10942597 DOI: 10.7554/elife.91407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2024] Open
Abstract
Background Primary angle closure glaucoma (PACG) is the leading cause of irreversible blindness in Asia, and no reliable, effective diagnostic, and predictive biomarkers are used in clinical routines. A growing body of evidence shows metabolic alterations in patients with glaucoma. We aimed to develop and validate potential metabolite biomarkers to diagnose and predict the visual field progression of PACG. Methods Here, we used a five-phase (discovery phase, validation phase 1, validation phase 2, supplementary phase, and cohort phase) multicenter (EENT hospital, Shanghai Xuhui Central Hospital), cross-sectional, prospective cohort study designed to perform widely targeted metabolomics and chemiluminescence immunoassay to determine candidate biomarkers. Five machine learning (random forest, support vector machine, lasso, K-nearest neighbor, and GaussianNaive Bayes [NB]) approaches were used to identify an optimal algorithm. The discrimination ability was evaluated using the area under the receiver operating characteristic curve (AUC). Calibration was assessed by Hosmer-Lemeshow tests and calibration plots. Results Studied serum samples were collected from 616 participants, and 1464 metabolites were identified. Machine learning algorithm determines that androstenedione exhibited excellent discrimination and acceptable calibration in discriminating PACG across the discovery phase (discovery set 1, AUCs=1.0 [95% CI, 1.00-1.00]; discovery set 2, AUCs = 0.85 [95% CI, 0.80-0.90]) and validation phases (internal validation, AUCs = 0.86 [95% CI, 0.81-0.91]; external validation, AUCs = 0.87 [95% CI, 0.80-0.95]). Androstenedione also exhibited a higher AUC (0.92-0.98) to discriminate the severity of PACG. In the supplemental phase, serum androstenedione levels were consistent with those in aqueous humor (r=0.82, p=0.038) and significantly (p=0.021) decreased after treatment. Further, cohort phase demonstrates that higher baseline androstenedione levels (hazard ratio = 2.71 [95% CI: 1.199-6.104], p=0.017) were associated with faster visual field progression. Conclusions Our study identifies serum androstenedione as a potential biomarker for diagnosing PACG and indicating visual field progression. Funding This work was supported by Youth Medical Talents - Clinical Laboratory Practitioner Program (2022-65), the National Natural Science Foundation of China (82302582), Shanghai Municipal Health Commission Project (20224Y0317), and Higher Education Industry-Academic-Research Innovation Fund of China (2023JQ006).
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Affiliation(s)
- Shengjie Li
- Department of Clinical Laboratory, Eye & ENT Hospital, Shanghai Medical College, Fudan UniversityShanghaiChina
- Department of Ophthalmology & Visual Science, Eye & ENT Hospital, Shanghai Medical College, Fudan UniversityShanghaiChina
- State Key Laboratory of Medical Neurobiology, Institutes of Brain Science, Fudan UniversityShanghaiChina
- Key Laboratory of Myopia, Chinese Academy of Medical SciencesShanghaiChina
- NHC Key Laboratory of Myopia, Fudan UniversityShanghaiChina
| | - Jun Ren
- Department of Clinical Laboratory, Eye & ENT Hospital, Shanghai Medical College, Fudan UniversityShanghaiChina
| | - Zhendong Jiang
- Department of Clinical Laboratory, Eye & ENT Hospital, Shanghai Medical College, Fudan UniversityShanghaiChina
| | - Yichao Qiu
- Department of Clinical Laboratory, Eye & ENT Hospital, Shanghai Medical College, Fudan UniversityShanghaiChina
| | - Mingxi Shao
- Department of Clinical Laboratory, Eye & ENT Hospital, Shanghai Medical College, Fudan UniversityShanghaiChina
| | - Yingzhu Li
- Department of Clinical Laboratory, Eye & ENT Hospital, Shanghai Medical College, Fudan UniversityShanghaiChina
| | - Jianing Wu
- Department of Clinical Laboratory, Eye & ENT Hospital, Shanghai Medical College, Fudan UniversityShanghaiChina
| | - Yunxiao Song
- Department of Clinical Laboratory, Shanghai Xuhui Central Hospital, Fudan UniversityShanghaiChina
| | - Xinghuai Sun
- Department of Ophthalmology & Visual Science, Eye & ENT Hospital, Shanghai Medical College, Fudan UniversityShanghaiChina
- State Key Laboratory of Medical Neurobiology, Institutes of Brain Science, Fudan UniversityShanghaiChina
- Key Laboratory of Myopia, Chinese Academy of Medical SciencesShanghaiChina
- NHC Key Laboratory of Myopia, Fudan UniversityShanghaiChina
| | - Shunxiang Gao
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of MedicineShanghaiChina
- National Clinical Research Center for Eye Diseases, Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai Engineering Center for Visual Science and PhotomedicineShanghaiChina
| | - Wenjun Cao
- Department of Clinical Laboratory, Eye & ENT Hospital, Shanghai Medical College, Fudan UniversityShanghaiChina
- Department of Ophthalmology & Visual Science, Eye & ENT Hospital, Shanghai Medical College, Fudan UniversityShanghaiChina
- State Key Laboratory of Medical Neurobiology, Institutes of Brain Science, Fudan UniversityShanghaiChina
- Key Laboratory of Myopia, Chinese Academy of Medical SciencesShanghaiChina
- NHC Key Laboratory of Myopia, Fudan UniversityShanghaiChina
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Espinoza G, Iglesias K, Parra JC, Rodriguez-Una I, Serrano-Gomez S, Prada AM, Galvis V. Agreement and Reproducibility of Anterior Chamber Angle Measurements between CASIA2 Built-In Software and Human Graders. J Clin Med 2023; 12:6381. [PMID: 37835024 PMCID: PMC10573880 DOI: 10.3390/jcm12196381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Revised: 10/03/2023] [Accepted: 10/04/2023] [Indexed: 10/15/2023] Open
Abstract
PURPOSE This study evaluated the agreement and reproducibility of ACA measurements obtained using the built-in software of the CASIA2 (Version 3G.1) and the measurements derived from expert clinicians. METHODS Healthy volunteers underwent ophthalmological evaluation and AS-OCT examination. ACA measurements derived from automated and manual SS location were obtained using the CASIA2 automated software and clinician identification, respectively. The intraobserver, interobserver reproducibility, CASIA2-human grader reproducibility and CASIA2 repeatability were assessed using intraclass correlation coefficients (ICCs). RESULTS The study examined 58 eyes of 30 participants. The CASIA2 software showed excellent repeatability for all ACA parameters (ICC > 0.84). Intraobserver, interobserver, and CASIA2-human grader reproducibility were also excellent (ICC > 0.87). Interobserver agreement was high, except for nasal TISA500, differing between observers 1 and 2 (p < 0.05). The agreement between CASIA2 measurements and human graders was high, except for nasal TISA500, where observer 1 values were smaller (p < 0.05). CONCLUSION The CASIA2 built-in software reliably measures ACA parameters in healthy individuals, demonstrating high consistency. Although a small difference was observed in nasal TISA500 measurements, interobserver and CASIA2-human grader reproducibility remained excellent. Automated SS detection has the potential to facilitate evaluation and monitoring of primary angle closure disease.
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Affiliation(s)
- Gustavo Espinoza
- Centro Oftalmológico Virgilio Galvis, Floridablanca 681004, Santander, Colombia
- Fundación Oftalmológica de Santander, Floridablanca 681004, Santander, Colombia
- Facultad de Ciencias de la Salud, Universidad Autónoma de Bucaramanga, Bucaramanga 680002, Santander, Colombia
| | - Katheriene Iglesias
- Fundación Oftalmológica de Santander, Floridablanca 681004, Santander, Colombia
| | - Juan C. Parra
- Fundación Oftalmológica de Santander, Floridablanca 681004, Santander, Colombia
- Facultad de Ciencias de la Salud, Universidad Autónoma de Bucaramanga, Bucaramanga 680002, Santander, Colombia
| | - Ignacio Rodriguez-Una
- Instituto Universitario Fernández-Vega, Fundación de Investigación Oftalmológica, Universidad de Oviedo, 33012 Oviedo, Spain;
| | - Sergio Serrano-Gomez
- Facultad de Ciencias de la Salud, Universidad Autónoma de Bucaramanga, Bucaramanga 680002, Santander, Colombia
| | - Angelica M. Prada
- Centro Oftalmológico Virgilio Galvis, Floridablanca 681004, Santander, Colombia
- Fundación Oftalmológica de Santander, Floridablanca 681004, Santander, Colombia
- Facultad de Ciencias de la Salud, Universidad Autónoma de Bucaramanga, Bucaramanga 680002, Santander, Colombia
| | - Virgilio Galvis
- Centro Oftalmológico Virgilio Galvis, Floridablanca 681004, Santander, Colombia
- Fundación Oftalmológica de Santander, Floridablanca 681004, Santander, Colombia
- Facultad de Ciencias de la Salud, Universidad Autónoma de Bucaramanga, Bucaramanga 680002, Santander, Colombia
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Zhou S, Pardeshi AA, Burkemper B, Apolo G, Cho A, Jiang X, Torres M, McKean-Cowdin R, Varma R, Xu BY. Refractive Error and Anterior Chamber Depth as Risk Factors in Primary Angle Closure Disease: The Chinese American Eye Study. J Glaucoma 2023; 32:257-264. [PMID: 36847699 PMCID: PMC10065888 DOI: 10.1097/ijg.0000000000002154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 10/06/2022] [Indexed: 03/01/2023]
Abstract
PRCIS The risk of primary angle closure disease (PACD) rises rapidly with greater hyperopia while remaining relatively low for all degrees of myopia. Refractive error (RE) is useful for angle closure risk stratification in the absence of biometric data. PURPOSE To assess the role of RE and anterior chamber depth (ACD) as risk factors in PACD. METHODS Chinese American Eye Study participants received complete eye examinations including refraction, gonioscopy, amplitude-scan biometry, and anterior segment ocular coherence tomography imaging. PACD included primary angle closure suspect (≥3 quadrants of angle closure on gonioscopy) and primary angle closure/primary angle closure glaucoma (peripheral anterior synechiae or intraocular pressure >21 mm Hg). Logistic regression models were developed to assess associations between PACD and RE and/or ACD adjusted for sex and age. Locally weighted scatterplot smoothing curves were plotted to assess continuous relationships between variables. RESULTS Three thousand nine hundred seventy eyes (3403 open angle and 567 PACD) were included. The risk of PACD increased with greater hyperopia [odds ratio (OR) = 1.41 per diopter (D); P < 0.001] and shallower ACD (OR = 1.75 per 0.1 mm; P < 0.001). Hyperopia (≥ + 0.5 D; OR = 5.03) and emmetropia (-0.5 D to +0.5 D; OR = 2.78) conferred a significantly higher risk of PACD compared with myopia (≤0.5 D). ACD (standardized regression coefficient = -0.54) was a 2.5-fold stronger predictor of PACD risk compared with RE (standardized regression coefficient = 0.22) when both variables were included in one multivariable model. The sensitivity and specificity of a 2.6 mm ACD cutoff for PACD were 77.5% and 83.2% and of a +2.0 D RE cutoff were 22.3% and 89.1%. CONCLUSION The risk of PACD rises rapidly with greater hyperopia while remaining relatively low for all degrees of myopia. Although RE is a weaker predictor of PACD than ACD, it remains a useful metric to identify patients who would benefit from gonioscopy in the absence of biometric data.
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Affiliation(s)
- Sarah Zhou
- Keck School of Medicine at the University of Southern California
| | | | | | - Galo Apolo
- Department of Ophthalmology, Roski Eye Institute
| | - Austin Cho
- Keck School of Medicine at the University of Southern California
| | - Xuejuan Jiang
- Department of Ophthalmology, Roski Eye Institute
- Department of Population and Public Health Sciences, Keck School of Medicine at the University of Southern California
| | - Mina Torres
- Southern California Eye Institute, CHA Hollywood Presbyterian Medical Center, Los Angeles, CA
| | - Roberta McKean-Cowdin
- Keck School of Medicine at the University of Southern California
- Department of Population and Public Health Sciences, Keck School of Medicine at the University of Southern California
| | - Rohit Varma
- Southern California Eye Institute, CHA Hollywood Presbyterian Medical Center, Los Angeles, CA
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Luo S, Yuan G, Zhao C, Shen J, Zhang L, Luo M, Chen W. Changes in Anterior Chamber Angle and Choroidal Thickness in Patients with Primary Angle-Closure Glaucoma after Phaco-Goniosynechialysis. J Clin Med 2023; 12. [PMID: 36675335 DOI: 10.3390/jcm12020406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Revised: 12/16/2022] [Accepted: 12/29/2022] [Indexed: 01/06/2023] Open
Abstract
We aimed to observe changes in angle width and choroidal thickness (CT) before and after phacoemulsification intraocular lens implantation (PEI) combined with goniosynechialysis (GSL) in patients with primary angle-closure glaucoma (PACG) complicated by cataracts. This prospective cohort study included 60 patients with PACG complicated by cataracts from the Department of Ophthalmology of Shaoxing People’s Hospital, China. Patients underwent PEI combined with GSL (PEI-GSL group) or laser peripheral iridotomy (LPI) followed by PEI (PEI group). Intraocular pressure (IOP) and endothelial counts were significantly decreased in both groups after surgery, while best-corrected visual acuity and central anterior chamber depth were significantly increased. However, there were no significant differences between the two groups. The opening degrees of room corners at 12, 3, 6, and 9 o’clock were recorded as AA12, AA3, AA6, and AA9, respectively. Anterior chamber depth was significantly increased postoperatively compared to preoperatively in both groups, with no significant between-group differences (all ps > 0.05). At 1, 3, and 6 months postoperatively, the width at AA12, AA3, and AA9 points was higher in the PEI-GSL group than in the PEI group (all ps < 0.05). Significant between-group differences at AA6 were observed preoperatively (p = 0.023) and at 1 (p = 0.027) and 3 (p = 0.033) months postoperatively but not at 6 months postoperatively (p = 0.055). CT was smaller postoperatively than preoperatively (all ps < 0.001). The present study suggests that patients with PACG who underwent PEI with or without GSL had reduced IOP and CT after surgery.
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Lei Q, Wang Y, Zhou H, Cao D, Hu J, Zhang W, Xing Y. Anterior chamber parameters in cataract surgery candidates from middle China. Medicine (Baltimore) 2022; 101:e32211. [PMID: 36626461 PMCID: PMC9750573 DOI: 10.1097/md.0000000000032211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
To determine the distribution of the anterior chamber parameters and associated factors in cataractous adults from middle China. In this cross-sectional study, axial length, anterior chamber depth (ACD) and lens thickness (LT) were measured with IOLMaster 700. The Pentacam HR was designed to measure the anterior chamber volume (ACV) and anterior chamber angle (ACA). Patients' data were collected and analyzed between 2020 and 2022. A total of 157 eyes of 157 Chinese adults (mean age: 64.43 ± 12.16 years) with a cataract were enrolled in this study. The mean values measured were as follows: axial length, 24.10 ± 2.44mm; ACD, 2.99 ± 0.52 mm; LT, 4.51 ± 0.48 mm; ACV, 113.98 ± 45.12 mm3; ACA, 32.33 ± 7.66 degrees. The ACD and ACV were statistically significantly greater in men than in women and had a decrease trend as age and LT increased. In the simulated linear equation of age with ACD and LT the absolute slope coefficients of equations were the same; however, the directions were opposite. The mean ACV was <100 mm3 when the patients were over 60 years. In the multivariate regression analysis of ACD, ACV and ACA there was a reasonable prediction with adjusted R2 = 0.878, 0.847 and 0.564, respectively. This study may provide normative data for cataract patients. The profile of anterior chamber can help improve the knowledge of the risk of angle closure in cataract candidates.
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Affiliation(s)
- Qiong Lei
- Department of Cataract and Glaucoma, Aier Eye Hospital of Wuhan University, Wuhan, China
| | - Yong Wang
- Department of Cataract and Glaucoma, Aier Eye Hospital of Wuhan University, Wuhan, China
| | - Hezheng Zhou
- Department of Cataract and Glaucoma, Aier Eye Hospital of Wuhan University, Wuhan, China
| | - Danmin Cao
- Department of Cataract and Glaucoma, Aier Eye Hospital of Wuhan University, Wuhan, China
| | - Jun Hu
- Department of Cataract and Glaucoma, Aier Eye Hospital of Wuhan University, Wuhan, China
| | - Wanping Zhang
- Department of Cataract and Glaucoma, Aier Eye Hospital of Wuhan University, Wuhan, China
| | - Yiqiao Xing
- Department of Cataract and Glaucoma, Aier Eye Hospital of Wuhan University, Wuhan, China
- Department of Ophthalmology, Renmin Hospital of Wuhan University, Wuhan, China
- * Correspondence: Yiqiao Xing, Department of Cataract and Glaucoma, Aier Eye Hospital of Wuhan University, Department of Ophthalmology, Renmin Hospital of Wuhan University, 159 Minzu Road Hongshan District, Wuhan, Hubei 430000, China (e-mail: )
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Song MK, Shin JW, Sung KR. Factors Associated with Deterioration of Primary Angle Closure after Lens Extraction. J Clin Med 2022; 11:2557. [PMID: 35566683 DOI: 10.3390/jcm11092557] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 04/20/2022] [Accepted: 04/27/2022] [Indexed: 02/01/2023] Open
Abstract
The purpose of the study was to explore factors associated with glaucomatous deterioration in eyes with primary angle closure (PAC) after lens extraction, including PAC suspect (PACS), PAC, and PAC glaucoma (PACG). We retrospectively analyzed data of 77 eyes with PACS, PAC, and PACG that underwent lens extraction with more than 2 years postoperative follow-up. Postoperative glaucoma progression was analyzed by either structural (optic disc/retinal nerve fiber layer (RNFL) photographs or optical coherent tomography (OCT)) or functional (visual field (VF)) criterion. Cox proportional hazard analysis (hazard ratio (HR)) was used to determine risk factors for progression using uni-and multivariate analysis. The analysis was conducted in groups with or without glaucomatous optic neuropathy (PACS/PAC vs. PACG). Forty-one eyes with PACS/PAC and 36 eyes with PACG were included. The mean postoperative follow-up period was 3.5 ± 1.4 years. Intraocular pressure (IOP) was reduced postoperatively from 23.1 ± 14.4 to 13.4 ± 2.1 mmHg. In the PACS/PAC group, seven eyes (17.0%) showed structural progression, but none showed progression in VF. Preoperative RNFL thickness was the only risk factor for structural progression (HR = 0.928, p = 0.002) in the PACS/PAC group. In the PACG group, 24 eyes (66.7%) showed structural progression and 12 eyes (33.3%) showed VF progression. Thinner preoperative RNFL thickness (HR = 0.964, p = 0.043) and high postoperative IOP fluctuation (HR = 1.296, p = 0.011) were significantly associated with VF progression; none of the factors were associated with structural progression. Angle closure eyes with thinner baseline RNFL thickness and higher postoperative IOP fluctuation may require careful follow-up for glaucoma progression after lens extraction.
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10
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Kurysheva NI, Sharova GA. [Comparative study of retinal microcirculation in primary angle closure disease and early primary open-angle glaucoma]. Vestn Oftalmol 2022; 138:44-51. [PMID: 35234420 DOI: 10.17116/oftalma202213801144] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To compare microcirculatory changes in patients with early stages of primary angle closure disease (PACD) and primary open-angle glaucoma (POAG). MATERIAL AND METHODS The study retrospectively analyzed the clinical data of 60 eyes with PACD, 30 with initial POAG, and 30 eyes without any ophthalmic pathologies. Vessel density (VD) in the optic nerve head and peripapillary retina (wiVD Disc), as well as in the inner layers of fovea and parafovea (wiVD Macula) and their different sectors were determined in all patients by optical coherence tomography angiography (OCTA). The correlation of VD with axial length (AL), anterior chamber depth (ACD), lens thickness (TL), and corneal-compensated intraocular pressure (IOPcc) was assessed. RESULTS The wiVD Disc in PACD (42.47±4.23%) was lower than in POAG eyes (47.46±2.10%), p<0.001, but the difference for wiVD Macula was not significant: 41.71±4.55% and 39.29±2.46%, respectively (p=0.47). In both PACD and POAG, all OCTA parameters were lower than in normal eyes: p=0.000 for both wiVD Disc and wiVD Macula. WiVD Disc correlated with ACD both in PACD (r=0.724, p=0.012) and in POAG (r= 0.685, p=0.012), but a correlation with IOPcc was found only in PACD (r= -0.670, p=0.033). The largest number of inverse correlations was found between TL and VD both for wiVD Disc (r= -0.714, p=0.006) and the parameters of macular area (in para- and perifovea). CONCLUSION OCTA parameters differ significantly from the norm even in the early stages of both PACD and POAG. In PACD, there was a significant decrease in microcirculation in the peripapillary retina compared to POAG, which had an inverse correlation with IOPcc; there was also an inverse correlation of OCTA parameters in the optic nerve head and macula with lens thickness.
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Affiliation(s)
- N I Kurysheva
- Medical and Biological University of Innovation and Continuing Education of the Federal Medical Biophysical Center named after A.I. Burnazyan, Moscow, Russia.,Consultative and Diagnostic Department of the Ophthalmological Center of the Federal Medical Biophysical Center named after A.I. Burnazyan, Moscow, Russia
| | - G A Sharova
- Eye Clinic of Doctor Belikova LLC, Moscow, Russia
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11
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Zhang Y, Zhang Q, Thomas R, Li SZ, Wang NL. Development of angle closure and associated risk factors: The Handan eye study. Acta Ophthalmol 2022; 100:e253-e261. [PMID: 33960669 PMCID: PMC9292978 DOI: 10.1111/aos.14887] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 04/04/2021] [Indexed: 12/13/2022]
Abstract
PURPOSE To investigate the development of angle closure from baseline open angle and associated risk factors in a rural Chinese population through a longitudinal study over a 5-year period. METHODS Subjects aged ≥30 years and older with bilateral open angles at baseline of the Handan Eye Study who participated in the follow-up and had undergone both baseline and follow-up gonioscopic examinations were included. Subjects with any form of angle closure, glaucoma, incisional ocular surgery or other conditions that could influence the results were excluded. The development of angle closure was defined as the presence of primary angle closure suspect (PACS) or primary angle closure (PAC)/primary angle closure glaucoma (PACG) during the follow-up in normal subjects with baseline bilateral open angles. Logistic regression was performed to identify the baseline risk factors for the development of angle closure. RESULTS A total of 457 subjects with bilateral open angles at baseline aged 53.0 (45.5, 58.0) years were enrolled. 94.7% of the included cases developed PACS, 5.3% developed PAC and no one developed PACG after 5 years. In logistic regression, significant risk factors for the development of angle closure were shallower central anterior chamber depth (ACD) (p = 0.002) and narrower mean angle width (p < 0.001). CONCLUSIONS This study reports the development from baseline open angle to angle closure after a 5-year follow-up. We confirm that the mean angle width and central ACD were independent predictive risk factors for the development of any form of angle closure.
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Affiliation(s)
- Ye Zhang
- Beijing Tongren Eye Center Beijing Key Laboratory of Ophthalmology and Visual Science Beijing Tongren Hospital Capital Medical University Beijing China
| | - Qing Zhang
- Beijing Institute of Ophthalmology Beijing China
| | - Ravi Thomas
- Queensland Eye Institute Brisbane Australia
- University of Queensland Brisbane Australia
| | | | - Ning Li Wang
- Beijing Tongren Eye Center Beijing Key Laboratory of Ophthalmology and Visual Science Beijing Tongren Hospital Capital Medical University Beijing China
- Beijing Institute of Ophthalmology Beijing China
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12
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Kurysheva NI, Sharova GA. [Primary anterior chamber angle closure: progression from suspect to glaucoma. Part 1. Frequency and rate of transition from suspected primary angle closure to true angle closure and primary angle closure glaucoma]. Vestn Oftalmol 2022; 138:101-107. [PMID: 36004598 DOI: 10.17116/oftalma2022138041101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
To review the literature devoted to the problem of primary anterior chamber angle closure (PAC) and the development of this pathology from glaucoma suspect to primary angle closure glaucoma. The paper includes a trend analysis of the studies concerning primary angle closure suspects (PACS). The concept of this review is conditioned by the conflicting strategies for treating patients with initial PAC without glaucomatous optic neuropathy. Solving the problem of angle closure plays a key role in preventing the development of PAC glaucoma, which is the world's leading cause of irreversible blindness. This part of the review provides information on the frequency and rate of disease progression in PACS. The analyzed literature data is contradictory and indicates the need for further search that would consider a standardized approach to defining the concept of PAC disease, demographic factors and unified examination methods for generalizing and systematizing data in order to draw out unified treatment recommendations.
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Affiliation(s)
- N I Kurysheva
- Medical and Biological University of Innovations and Continuing Education of the State Research Center - Burnasyan Federal Biophysical Center, Moscow, Russia
- Ophthalmological Center of the State Research Center - Burnasyan Federal Biophysical Center, Moscow, Russia
| | - G A Sharova
- Eye Clinic of Doctor Belikova LLC, Moscow, Russia
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13
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Xu M, Yang J, Sun J, Xing X, Liu Z, Liu T. A novel mutation in PCK2 gene causes primary angle-closure glaucoma. Aging (Albany NY) 2021; 13:23338-23347. [PMID: 34650006 PMCID: PMC8544327 DOI: 10.18632/aging.203627] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 10/03/2021] [Indexed: 12/25/2022]
Abstract
Primary angle-closure glaucoma (PACG) is an ophthalmic genetic disease characterized by direct contact between the iris and trabecular meshwork, resulting in an obstructed outflow of aqueous humor from the eye. However, it is unclear as to what role genetics plays in the development of PACG. The present study investigated the disease-causing mutation in a five-generation Chinese PACG family using whole-genome sequencing. A novel heterozygous missense mutation c.977C>T in PCK2 gene was identified in five affected family members, but not in any unaffected and 86 unrelated healthy individuals. This nucleotide substitute is predicted to result in a proline to leucine substitution p.Pro326Leu. Furthermore, the function of this mutation was analyzed through various in vitro assays using the RGC-5 cell line. Our results demonstrate that the p.Pro326Leu mutation induces RGC-5 cell cycle arrest and apoptosis with a decreased BcL-XL. The increasing P53, P27, P21, AKT, and P-GSK3α were also detected in the cells transfected with c.977C>T mutation, suggesting that this mutation within PCK2 gene cause PACG through impairment of AKT/GSK3α signaling pathway.
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Affiliation(s)
- Menghan Xu
- Department of Ophthalmology, 3201 Hospital, Xi'an Jiaotong University Health Science Center, Hanzhong, Shaanxi 723000, China.,The First People's Hospital of Xianyang, Xianyang, Shaanxi 712000, China
| | - Jin Yang
- Department of Ophthalmology, 3201 Hospital, Xi'an Jiaotong University Health Science Center, Hanzhong, Shaanxi 723000, China.,Department of Ophthalmology, Shaanxi Provincial People's Hospital, Xi'an, Shaanxi 710068, China
| | - Jiayue Sun
- Department of Ophthalmology, 3201 Hospital, Xi'an Jiaotong University Health Science Center, Hanzhong, Shaanxi 723000, China
| | - Xuemei Xing
- Department of Ophthalmology, 3201 Hospital, Xi'an Jiaotong University Health Science Center, Hanzhong, Shaanxi 723000, China
| | - Zheng Liu
- College of Medical Laboratory Science, Guilin Medical University, Guilin, Guangxi 541004, China
| | - Tao Liu
- Department of Ophthalmology, 3201 Hospital, Xi'an Jiaotong University Health Science Center, Hanzhong, Shaanxi 723000, China.,Guihang Guiyang Hospital Affiliated to Zunyi Medical University, Guiyang, Guizhou 550000, China
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14
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Helmy H. Long-Term Effect of Early Phacoemulsification in Primary Angle Closure Glaucoma Patients with Cataract: A 10-Year Follow-Up Study. Clin Ophthalmol 2021; 15:3969-3981. [PMID: 34616141 PMCID: PMC8488041 DOI: 10.2147/opth.s333202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Accepted: 09/20/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose To assess the 10-year effects of early phacoemulsification with intraocular lens (IOL) implantation in primary angle closure glaucoma (PACG) patients with cataract. Patients and Methods This prospective cohort study included 102 eyes of 102 patients with PACG. All patients had coexisting cataracts compromising vision. Patients underwent phacoemulsification and foldable IOL implantation. The main outcome measures were anterior chamber depth (ACD), angle width, value of intraocular pressure (IOP), and number of medications needed postoperatively and during follow-up. Results Half (53%) of the patients were female, with ages ranging from 55 to 73 with a mean of 59.82±5.19 years. Mean IOP decreased significantly from 22.15±2.08 mmHg at baseline to 14.08±2.13 mmHg postoperatively (p˂ 0.05). The ACD increased from 2.2±0.21 preoperatively to 3.73±0.25 postoperatively (p˂0.001). Nasal angle width increased postoperatively to 40.05±2.09 compared to the preoperative value of 16.02±2.08 (p˂0.001). Temporal angle width increased from 13.05±2.07 to 41.9600±1.94 (p˂0.001). Anti-glaucoma treatment significantly decreased postoperatively (p˂0.001). A significant positive correlation was detected between ACD and angle width, while a negative correlation was detected between IOP and both ACD and angle width (p˂0.001). There was also a significant negative correlation between postoperative angle width and IOP (p˂0.001). Preoperative lens thickness was positively correlated with preoperative IOP and number of medications, while it was negatively correlated with preoperative AC depth and angle width. Preoperative lens thickness positively correlated with postoperative IOP and medications. Complete and qualified success was achieved in 69.65% and 30.4% of cases, respectively, while 2.9% failed to be controlled. Visual acuity significantly improved from 0.17±0.1 to 0.9±0.08 (p˂0.001). All parameters showed high stability throughout the follow-up period. Conclusion Phacoemulsification with IOL implantation is a safe and effective early modality for long-term control of IOP in PACG patients with coexisting cataract. The effects can persist for at least 10 years.
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Affiliation(s)
- Hazem Helmy
- Glaucoma and Optic Nerve Disease Department, Research Institute of Ophthalmology, Giza, Egypt
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15
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Semba RD, Zhang P, Dufresne C, Gao T, Al-Jadaan I, Craven ER, Qian J, Edward DP, Mahale A. Primary angle closure glaucoma is characterized by altered extracellular matrix homeostasis in the iris. Proteomics Clin Appl 2021; 15:e2000094. [PMID: 34240827 DOI: 10.1002/prca.202000094] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 06/19/2021] [Accepted: 07/06/2021] [Indexed: 11/10/2022]
Abstract
PURPOSE To characterize the proteome of the iris in primary angle closure glaucoma (PACG). EXPERIMENTAL DESIGN In this cross-sectional study, iris samples were obtained from surgical iridectomy of 48 adults with PACG and five normal controls. Peptides from iris were analysed using liquid chromatography-tandem mass spectrometry on an Orbitrap Q Exactive Plus mass spectrometer. Verification of proteins of interest was conducted using selected reaction monitoring on a triple quadrupole mass spectrometer. The main outcome was proteins with a log2 two-fold difference in expression in iris between PACG and controls. RESULTS There were 3,446 non-redundant proteins identified in human iris, of which 416 proteins were upregulated and 251 proteins were downregulated in PACG compared with controls. Thirty-two upregulated proteins were either components of the extracellular matrix (ECM) (fibrillar collagens, EMILIN-2, fibrinogen, fibronectin, matrilin-2), matricellular proteins (thrombospondin-1), proteins involved in cell-matrix interactions (integrins, laminin, histidine-rich glycoprotein, paxillin), or protease inhibitors known to modulate ECM turnover (α-2 macroglobulin, tissue factor pathway inhibitor 2, papilin). Two giant proteins, titin and obscurin, were up- and down-regulated, respectively, in the iris in PACG compared with controls. CONCLUSIONS AND CLINICAL RELEVANCE This proteomic study shows that ECM composition and homeostasis are altered in the iris in PACG.
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Affiliation(s)
- Richard D Semba
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Pingbo Zhang
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | | | - Tianshun Gao
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | | | - Earl R Craven
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Jiang Qian
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Deepak P Edward
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Alka Mahale
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
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16
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Chiang M, Guth D, Pardeshi AA, Randhawa J, Shen A, Shan M, Dredge J, Nguyen A, Gokoffski K, Wong BJ, Song B, Lin S, Varma R, Xu BY. Glaucoma Expert-Level Detection of Angle Closure in Goniophotographs With Convolutional Neural Networks: The Chinese American Eye Study. Am J Ophthalmol 2021; 226:100-107. [PMID: 33577791 DOI: 10.1016/j.ajo.2021.02.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 01/20/2021] [Accepted: 02/03/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE To compare the performance of a novel convolutional neural network (CNN) classifier and human graders in detecting angle closure in EyeCam (Clarity Medical Systems, Pleasanton, California, USA) goniophotographs. DESIGN Retrospective cross-sectional study. METHODS Subjects from the Chinese American Eye Study underwent EyeCam goniophotography in 4 angle quadrants. A CNN classifier based on the ResNet-50 architecture was trained to detect angle closure, defined as inability to visualize the pigmented trabecular meshwork, using reference labels by a single experienced glaucoma specialist. The performance of the CNN classifier was assessed using an independent test dataset and reference labels by the single glaucoma specialist or a panel of 3 glaucoma specialists. This performance was compared to that of 9 human graders with a range of clinical experience. Outcome measures included area under the receiver operating characteristic curve (AUC) metrics and Cohen kappa coefficients in the binary classification of open or closed angle. RESULTS The CNN classifier was developed using 29,706 open and 2,929 closed angle images. The independent test dataset was composed of 600 open and 400 closed angle images. The CNN classifier achieved excellent performance based on single-grader (AUC = 0.969) and consensus (AUC = 0.952) labels. The agreement between the CNN classifier and consensus labels (κ = 0.746) surpassed that of all non-reference human graders (κ = 0.578-0.702). Human grader agreement with consensus labels improved with clinical experience (P = 0.03). CONCLUSION A CNN classifier can effectively detect angle closure in goniophotographs with performance comparable to that of an experienced glaucoma specialist. This provides an automated method to support remote detection of patients at risk for primary angle closure glaucoma.
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Zhong L, Zuo J, Jin Q, Xing J, Zhou X. Evaluation of phacoemulsification (ultrasound) cataract surgery on the dynamics of the anterior segment of primary angle closure by AS-OCT. Am J Transl Res 2021; 13:3156-3164. [PMID: 34017484 PMCID: PMC8129420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 02/01/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To explore the changes of anatomical biological parameters and dynamic parameters of the anterior segment (AS) before and after primary angle closure glaucoma (PACG) surgery. METHODS The clinical data of 82 patients (82 eyes) who underwent phacoemulsification in our hospital were retrospectively analyzed and divided into group A (angle closure, n = 38) and group B (normal open angle, n = 44). The anatomical biological parameters and dynamic parameters were compared between the two groups before and after surgery. RESULTS Compared with group B, group A had smaller anterior chamber depth, higher vaulting, greater iris curvature, and smaller TISA500. Compared with group B, group A had smaller ΔTISA500 and ΔI-area. Compared with group B, the TISA500 was smaller in group A preoperatively, at 1 week, and 1 month after surgery (P < 0.05). The iris curvature was larger in group A (P < 0.05). The ΔI-area was significantly reduced in group B at 1 week and 1 month after surgery. Group B exhibited smaller ΔI-curv than group A at 1 week and 1 month after surgery (P < 0.05). CONCLUSION Anterior segment optical coherence tomography (AS-OCT) can effectively monitor the dynamic changes (DC) of the AS caused by phacoemulsification in patients with primary angle closure (PAC). Phacoemulsification can open the primary of PAC patients. However, their iris area does not change significantly. The biological characteristics of the iris itself may be a risk factor leading to PAC.
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Affiliation(s)
- Lu Zhong
- Department of Ophthalmology, Jiangsu Province Hospital of Chinese Medicine Nanjing 210029, Jiangsu Province, China
| | - Jing Zuo
- Department of Ophthalmology, Jiangsu Province Hospital of Chinese Medicine Nanjing 210029, Jiangsu Province, China
| | - Qingzi Jin
- Department of Ophthalmology, Jiangsu Province Hospital of Chinese Medicine Nanjing 210029, Jiangsu Province, China
| | - Jing Xing
- Department of Ophthalmology, Jiangsu Province Hospital of Chinese Medicine Nanjing 210029, Jiangsu Province, China
| | - Xin Zhou
- Department of Ophthalmology, Jiangsu Province Hospital of Chinese Medicine Nanjing 210029, Jiangsu Province, China
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18
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Potop V, Coviltir V, Schmitzer S, Dragosloveanu CDM, Ionescu CI, Burcel MG, Corbu MC, Dăscălescu DMC. Ultrasound biomicroscopy in glaucoma assessment. Rom J Ophthalmol 2021; 65:114-119. [PMID: 34179574 PMCID: PMC8207866 DOI: 10.22336/rjo.2021.24] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/09/2021] [Indexed: 12/12/2022] Open
Abstract
Ultrasound biomicroscopy (UBM) is an important tool in the diagnosis, evaluation and follow up of glaucoma patients. Even if we are dealing with a primary angle closure glaucoma (PACG) or a primary open angle glaucoma (POAG) patient, the mechanism of angle closure can be revealed by performing an UBM. The device can help differentiate between the two types of glaucoma even in patients with opaque corneas when gonioscopy cannot be performed. Knowing the type of glaucoma is vital, especially regarding an individualized treatment, since each patient is unique and needs to be treated accordingly, in order to prevent glaucomatous optic neuropathy and visual field loss. Abbreviations: AC = anterior chamber, ICE = iridocorneal endothelial syndrome, IOP = intraocular pressure, NTG = normal tension glaucoma, PACG = primary angle closure glaucoma, PC = posterior chamber, PEX = pseudoexfoliation syndrome, POAG = primary open angle glaucoma, UBM = ultrasound biomicroscopy.
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Affiliation(s)
- Vasile Potop
- Ophthalmology Department, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
- Ophthalmology Department, Clinical Hospital of Ophthalmologic Emergencies, Bucharest, Romania
| | - Valeria Coviltir
- Ophthalmology Department, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
- Ophthalmology Department, Clinical Hospital of Ophthalmologic Emergencies, Bucharest, Romania
| | - Speranţa Schmitzer
- Ophthalmology Department, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
- Ophthalmology Department, Clinical Hospital of Ophthalmologic Emergencies, Bucharest, Romania
| | - Christiana Diana Maria Dragosloveanu
- Ophthalmology Department, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
- Ophthalmology Department, Clinical Hospital of Ophthalmologic Emergencies, Bucharest, Romania
| | | | | | - Maria Cristina Corbu
- Ophthalmology Department, Clinical Hospital of Ophthalmologic Emergencies, Bucharest, Romania
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Wang X, Chen J, Kong X, Sun X. Quantification of Retinal Microvascular Density Using Optic Coherence Tomography Angiography in Primary Angle Closure Disease. Curr Eye Res 2020; 46:1018-1024. [PMID: 33170750 DOI: 10.1080/02713683.2020.1849728] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Purpose: To evaluate the microvascular density of the peripapillary and parafoveal areas of the eyes with primary angle closure disease (PACD) using optical coherence tomography angiography (OCTA).Materials and methods: An observational study was conducted with 76 PACD patients (29 eyes with primary angle closure suspect, 22 eyes with primary angle closure [PAC], and 25 eyes with primary angle closure glaucoma [PACG]) and 27 control eyes. OCTA was performed for all subjects to acquire a 4.5 × 4.5 mm scanning area centered on the optic discs and a 3 × 3 mm parafoveal cubes. Peripapillary and parafoveal vessel density (VD) were compared between these four groups, and the relationship between VD values and structural and functional changes was evaluated.Results: Among all four groups, the peripapillary VD of the PACG eyes was the lowest in all six sections (all P < .01), while the parafoveal VD was lower than that of the normal group only in the average, superior, and inferior areas (all P < .05). The PAC group had lower peripapillary VD than the normal group (62.6[55.2-67.4] vs. 66.7[54.7-69.3], P = .01), while their retinal nerve fiber layer (RNFL) and ganglion cell complex thickness were not significantly different than those of the control group (all P > .05). In addition, the stages of PACD, visual field mean deviation, and RNFL thickness were shown to be predictors of the peripapillary VD in the multiple linear regression analysis.Conclusions: The PAC eyes had lower peripapillary VD than normal eyes when their RNFL and GCC thickness did not differ. This suggests that a reduction in retinal VD may occur before structural loss in PAC eyes. Retinal VD measurement may be a useful tool for the assessment of PACD.
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Affiliation(s)
- Xiaolei Wang
- Department of Ophthalmology and Visual Science, Eye, Ear, Nose and Throat Hospital, Shanghai Medical College of Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia, Ministry of Health (Fudan University), and Shanghai Key Laboratory of Visual Impairment and Restoration (Fudan University), Shanghai, China
| | - Junyi Chen
- Department of Ophthalmology and Visual Science, Eye, Ear, Nose and Throat Hospital, Shanghai Medical College of Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia, Ministry of Health (Fudan University), and Shanghai Key Laboratory of Visual Impairment and Restoration (Fudan University), Shanghai, China
| | - Xiangmei Kong
- Department of Ophthalmology and Visual Science, Eye, Ear, Nose and Throat Hospital, Shanghai Medical College of Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia, Ministry of Health (Fudan University), and Shanghai Key Laboratory of Visual Impairment and Restoration (Fudan University), Shanghai, China
| | - Xinghuai Sun
- Department of Ophthalmology and Visual Science, Eye, Ear, Nose and Throat Hospital, Shanghai Medical College of Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia, Ministry of Health (Fudan University), and Shanghai Key Laboratory of Visual Impairment and Restoration (Fudan University), Shanghai, China.,State Key Laboratory of Medical Neurobiology, Institutes of Brain Science, and Collaborative Innovation Center for Brain Science, Fudan University, Shanghai, China
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20
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Liu C, Nongpiur ME, Cheng CY, Khor CC, Yu M, Husain R, Ho CL, Wong TT, Boey PY, Perera S, Wong TY, Vithana EN, Aung T. Evaluation of Primary Angle-Closure Glaucoma Susceptibility Loci for Estimating Angle Closure Disease Severity. Ophthalmology 2021; 128:403-9. [PMID: 32682838 DOI: 10.1016/j.ophtha.2020.07.027] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 07/06/2020] [Accepted: 07/08/2020] [Indexed: 01/21/2023] Open
Abstract
PURPOSE To investigate whether recently identified genetic loci for primary angle-closure glaucoma (PACG) are associated with disease severity. DESIGN Case-control study. PARTICIPANTS Eight hundred four PACG patients and 943 control participants of Chinese ethnicity from Singapore. METHODS The 8 PACG-associated single nucleotide polymorphisms (SNPs; rs11024102 at PLEKHA7, rs3753841 at COL11A1, rs1015213 located between PCMTD1 and ST18 on chromosome 8q, rs3816415 at EPDR1, rs1258267 at CHAT, rs736893 at GLIS3, rs7494379 at FERMT2, and rs3739821 mapping in between DPM2 and FAM102A) identified from genome-wide association studies were tested for association with disease severity using logistic regression adjusted for age and gender. A P value of 0.006 was set as significant after Bonferroni correction for testing of 8 loci. We also calculated the weighted genetic risk score (GRS) weighted by the estimated individual SNP effect size on PACG calculated as logarithm of the odds ratio (OR). Disease severity was based on the visual field mean deviation (MD) and classified as early to moderate (MD, >-12 dB) and severe (MD, <-20 dB). MAIN OUTCOME MEASURES Association of PACG loci with severe disease. RESULTS Of the 804 PACG patients, genotyping data were available for 768 individuals and included 436 with mild-to-moderate PACG and 206 with severe PACG. The PACG patients were significantly older (mean age, 64.3 ± 9.1 years vs. 56.4 ± 8.9 years; P < 0.001) and there were proportionately more women compared with control participants (58.4% vs. 49.0%; P < 0.001). Of the 8 loci investigated, we observed significant evidence of association with severe PACG at 1 SNP, namely rs3816415 in EPDR1 (OR, 2.03; 95% confidence interval [CI], 1.49-2.78; P = 1 × 10-5). A higher-weighted GRS was associated significantly with severe PACG, with an OR of 3.11 (95% CI, 1.95-4.96) comparing the lowest quartile with the highest quartile. CONCLUSIONS Our results show that EPDR1 is associated significantly with severe PACG, suggesting that it may predispose patients to more aggressive disease development. Individuals with PACG with a higher GRS were associated with a higher risk of severe PACG.
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21
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Qiao C, Jia H, Zhang H, Wang H, Liang J, Song J, Li L, Duan X, Cao K, Hu J. Coding Variants in HOOK2 and GTPBP3 May Contribute to Risk of Primary Angle Closure Glaucoma. DNA Cell Biol 2020; 39:949-957. [PMID: 32397755 DOI: 10.1089/dna.2019.5079] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Primary angle closure glaucoma (PACG) is a major cause of blindness worldwide. This study proposed to screen candidate PACG-associated variants in Chinese Han people. Whole exome sequencing was applied to five confirmed PACG patients and two primary angle closure suspect individuals within a PACG-enriched Chinese Han family. A series of bioinformatics analyses were implemented to obtain high-risk single nucleotide variant (SNV) loci for PACG, which were subsequently used for linkage analysis for identifying linkage genome regions. In addition, MassARRAY SNV genotyping was applied to high-risk PACG loci as well as those within linkage regions in another independent cohort including 251 PACG and 251 normal samples to further screen high-confidence SNVs. A total of 27 loci in 19 genes remained after linkage analysis. The 19 genes were significantly enriched in biological processes tightly related to PACG, including retinol metabolism and salmonella infection. Two nonsynonymous SNV loci, rs897804 in exon15 of HOOK2 and rs3745193 in exon7 of GTPBP3, were recognized with higher variant frequency in PACG samples than that in control samples after association analysis of MassARRAY SNV genotyping data. This study sheds new light on the understanding of PACG incidence among Chinese Han people.
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Affiliation(s)
- Chunyan Qiao
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, P.R. China.,Beijing Ophthalmology and Visual Science Key Lab, Beijing, P.R. China
| | - Hongyan Jia
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, P.R. China.,Beijing Ophthalmology and Visual Science Key Lab, Beijing, P.R. China
| | - Hui Zhang
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, P.R. China.,Beijing Ophthalmology and Visual Science Key Lab, Beijing, P.R. China
| | - Hui Wang
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, P.R. China.,Beijing Ophthalmology and Visual Science Key Lab, Beijing, P.R. China
| | - Jing Liang
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, P.R. China.,Beijing Ophthalmology and Visual Science Key Lab, Beijing, P.R. China
| | - Jing Song
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, P.R. China.,Beijing Ophthalmology and Visual Science Key Lab, Beijing, P.R. China
| | - Liang Li
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, P.R. China.,Beijing Ophthalmology and Visual Science Key Lab, Beijing, P.R. China
| | - Xiaoming Duan
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, P.R. China.,Beijing Ophthalmology and Visual Science Key Lab, Beijing, P.R. China
| | - Kai Cao
- Beijing Ophthalmology and Visual Science Key Lab, Beijing, P.R. China.,Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing, P.R. China
| | - Jianping Hu
- Beijing Ophthalmology and Visual Science Key Lab, Beijing, P.R. China.,Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing, P.R. China
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22
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Kurysheva NI, Lepeshkina LV, Shatalova EO. [Comparative study of factors associated with the progression of primary open-angle and angle-closure glaucoma]. Vestn Oftalmol 2020; 136:64-72. [PMID: 32366072 DOI: 10.17116/oftalma202013602164] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
PURPOSE To compare the factors associated with the progression of primary open-angle glaucoma (POAG) and primary angle-closure glaucoma (PACG). MATERIAL AND METHODS This prospective study analyses clinical data of POAG and PACG patients followed up for 6 years. The progression of glaucomatous optic neuropathy (GON) was determined using perimetry and spectral optical coherence tomography (OCT). The value of each diagnostic indicator (z-value) was calculated using the Wilcoxon-Mann-Whitney test and the area under the ROC-curve (AUC) to identify the parameters reliably associated with the progression in both groups of patients. RESULTS According to OCT, 47.3% of PACG patients and 52.46% of POAG patients had GON progressing, while according to perimetry, these figures were 21.8% and 23%, respectively. The common factors associated with progression of these glaucoma forms were age (AUC 0.7, z -1.9 in PACG and AUC 0.7, z -2.9 in POAG) and maximum IOP (0.7; -2.7 in PACG and 0.79; -5.4 in POAG). The progression of PACG is associated with lens size (0.7; -2.4), subfoveal choroidal thickness (AUC 0.8, z -3.3) and peripapillary choroidal thickness (0.79; -3.2), resistive index in the vortex veins (0.81; -3.3) and their end diastolic blood flow velocity (0.83; 3.2). The progression of POAG is associated with a thin peripapillary (0.75; 2.6) and subfoveal choroid (0.74; 2.5), increased resistive index in the posterior short ciliary arteries (0.8; -2.3), and initial retinal nerve fiber layer (RNFL) thickness: 0.69; 2.9. CONCLUSION The progression of POAG and PACG has only two common factors - age and maximum IOP. The progression of PACG is mainly related to the lens size, venous dysfunction and the choroid expansion, while the progression of POAG is related to the initial RNFL thickness, reduced arterial blood flow and choroid thinning.
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Affiliation(s)
- N I Kurysheva
- Ophthalmological Center of the Federal Medical-Biological Agency of the Russia, A.I. Burnazyan Federal Medical and Biophysical Center of FMBA, Moscow, Russia
| | - L V Lepeshkina
- Ophthalmological Center of the Federal Medical-Biological Agency of the Russia, A.I. Burnazyan Federal Medical and Biophysical Center of FMBA, Moscow, Russia
| | - E O Shatalova
- Clinics of doctor ShatalovA Naberezhnaja St., Orekhovo-Zuyevo, Moscow region, Russia
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23
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Abstract
PURPOSE To study the changes in central corneal thickness (CCT) and corneal hysteresis (CH) after selective laser trabeculoplasty (SLT) in primary open-angle glaucoma (POAG) and primary angle-closure glaucoma (PACG) after laser peripheral iridotomy (LPI) and to determine their effect on the prognosis of the surgery. MATERIAL AND METHODS The prospective study involved 68 eyes with initial PACG after LPI and 74 eyes with initial POAG observed for 6 months. Corneal-compensated IOP (IOPcc), corneal resistance factor (CRF), CH and CCT were studied as the predictors of SLT, which was considered successful when IOPcc decreased by 20% or more from the baseline without additional hypotensive therapy and/or repeated SLT. RESULTS In both forms of glaucoma, CCT increased within the first hour after SLT: 567±24.08 µm (p=0.001) in POAG, and 572±21.41 µm (p=0.000) - persisting for over a month - in PACG. CCT correlated with laser energy at all stages of the examination both in POAG and PACG patients. The following predictors of SLT failure were determined: CH (p=0.000 in PACG and p=0.001 in POAG), as well as initial IOP (p=0.010 in PACG and p=0.016 in POAG) and CRF (p=0.003 in PACG and p=0.005 in POAG) and CCT (p=0.023 in PACG and p=0.026 in POAG). The value of anterior chamber angle (ACA) was a predictor only for PACG (p=0.011). CONCLUSION SLT leads to an increase in CCT, which lasts longer in PACG after LPI than in POAG and correlates with the level of laser energy. Lower CH and initially higher IOP are the common predictors of SLT failure in the long term for both forms of glaucoma. Smaller ACA have a negative prognostic sign in POAG.
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Affiliation(s)
- N I Kurysheva
- Ophthalmological Center of the Federal Medical-Biological Agency of the Russian Federation, A.I. Burnazyan Federal Medical and Biophysical Center of FMBA, 15 Gamalei St., Moscow, Russian Federation, 123098
| | - L V Lepeshkina
- Ophthalmological Center of the Federal Medical-Biological Agency of the Russian Federation, A.I. Burnazyan Federal Medical and Biophysical Center of FMBA, 15 Gamalei St., Moscow, Russian Federation, 123098
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24
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Chong Seong NT, Yaakub A, Jalil RA, Tirmandas Vn K, A/P Sandragasu T, Noor JBM, Husain NB, Mustari ZB, Hamid SAA, Mt Saad AB, At LS. Effect of physical activity on severity of primary angle closure glaucoma. Ther Adv Ophthalmol 2019; 11:2515841419864855. [PMID: 31384724 PMCID: PMC6664631 DOI: 10.1177/2515841419864855] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Accepted: 06/24/2019] [Indexed: 01/13/2023] Open
Abstract
Objective: To determine the association between physical activity and severity of
primary angle closure glaucoma in Malay patients. Methods: A cross-sectional study was conducted involving 150 primary angle closure
glaucoma patients between April 2014 and August 2016. Using the
International Physical Activity Questionnaire, the physical activity status
was assessed and divided into three categories: mild, moderate and heavy
physical activity. The duration of physical activity and corresponding
minimum energy requirements were calculated. Ocular examination was
performed including Humphrey visual field 24-2 analysis assessment. Based on
two consecutive reliable Humphrey visual fields, the severity of glaucoma
was scored according to modified Advanced Glaucoma Intervention Study and
classified as mild (0–5), moderate (6–11) and severe (12–20). Association
between physical activity and Advanced Glaucoma Intervention Study score was
determined with multiple linear regression analysis. Results: A total of 150 Malay patients with primary angle closure glaucoma were
included (50 patients with mild, 50 with moderate and 50 with severe
glaucoma). Physical activity showed inverse association with the severity of
primary angle closure glaucoma. After calculating adjustments for age, sex,
duration of glaucoma, body mass index, systemic co-morbidities, family
history of glaucoma, myopia and educational status [adjusted
b –3.41, 95% confidence interval (–5.23, –1.59),
p < 0.001], there was also an inverse relationship
with Advanced Glaucoma Intervention Study score. Every increase in physical
activity level reduces the Advanced Glaucoma Intervention Study score by 3.4
point. Conclusion: Physical activity is the potential modifiable risk factor in reducing the
severity of glaucoma among primary angle closure glaucoma patients. However,
there is possibility of the severity of glaucoma restricted the physical
activity of primary angle closure glaucoma patients.
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Affiliation(s)
- Niven Teh Chong Seong
- Department of Ophthalmology, School of Medical Sciences, Universiti Sains Malaysia, Kota Bharu, Malaysia
| | - Azhany Yaakub
- Department of Ophthalmology, School of Medical Sciences, Universiti Sains Malaysia, Kota Bharu, Malaysia
| | - Rohana Abdul Jalil
- Department of Community Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kota Bharu, Malaysia
| | - Karunakar Tirmandas Vn
- Department of Ophthalmology, Hospital Kuala Lumpur, Wilayah Persekutuan Kuala Lumpur, Malaysia
| | | | - Jelinar Binti Mohd Noor
- Department of Ophthalmology, Hospital Kuala Lumpur, Wilayah Persekutuan Kuala Lumpur, Malaysia
| | - Norhalwani Bt Husain
- Department of Ophthalmology, Hospital Raja Perempuan Zainab II, Kota Bharu, Malaysia
| | | | - Siti Azrin Ab Hamid
- Department of Biostatistics and Research Methodology, School of Medical Sciences, Universiti Sains Malaysia, Kota Bharu, Malaysia
| | - Ahmad B Mt Saad
- Department of Ophthalmology, Hospital Sultanah Bahiyah, Alor Setar, Malaysia
| | - Liza-Sharmini At
- Professor of Ophthalmology and Senior Consultant Ophthalmologist (Glaucoma), Head of Department, Department of Ophthalmology, School of Medical Sciences, Universiti Sains Malaysia, Health Campus, 16150 Kota Bharu, Kelantan, Malaysia
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25
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Paschalis EI, Taniguchi EV, Chodosh J, Pasquale LR, Colby K, Dohlman CH, Shen LQ. Blood Levels of Tumor Necrosis Factor Alpha and Its Type 2 Receptor Are Elevated in Patients with Boston Type I Keratoprosthesis. Curr Eye Res 2019; 44:599-606. [PMID: 30632412 DOI: 10.1080/02713683.2019.1568500] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Purpose: Boston keratoprosthesis (KPro) patients are prone to glaucoma even with well-controlled intraocular pressure (IOP). Recent experimental data have shown that soluble tumor necrosis factor alpha (TNF-α) after ocular injury may contribute to progressive retinal damage and subsequent glaucoma. This study evaluates the blood plasma levels of soluble TNF-α, TNF receptors 1 (TNFR1) and 2 (TNFR2), and leptin in patients with Boston type I KPro. Methods: Venous blood samples were collected from KPro patients with glaucoma (KPro G, n = 19), KPro patients without glaucoma (KPro NoG, n = 12), primary angle closure glaucoma without KPro (PACG, n = 13), and narrow angles without glaucoma or KPro (NA, n = 21). TNF-α, TNFR1, TNFR2, and leptin levels were quantified using the enzyme-linked immunosorbent assay. Erythrocyte sedimentation rate (ESR) was assessed using the Westergren test. Patients with underlying autoimmune conditions or diabetes were excluded from the study. Results: All groups had similar age, body mass index (BMI), IOP, and ESR (p ≥ 0.11). The mean time from KPro surgery to blood draw was 5.3 ± 3.7 years. Compared to NA patients (0.72 ± 0.3 pg/ml), KPro G and KPro NoG patients had higher blood plasma levels of TNF-α (1.18 ± 0.58 pg/ml, p = 0.006; 1.16 ± 0.50 pg/ml, p = 0.04, respectively). Similarly, KPro G patients had higher blood plasma levels of TNFR2 (2768 ± 1368 pg/ml) than NA patients (2020 ± 435 pg/ml, p = 0.048). In multivariate analysis, KPro status remained positively associated with TNF-α levels (β = 0.36; 95% confidence intervals [CI]: 0.14-0.58; p = 0.002) and TNFR2 levels (β = 458.3; 95% CI: 32.8-883.7; p = 0.035) after adjusting for age, gender, BMI, glaucoma status, and ESR. TNFR1 and leptin levels were not significantly different in the study groups. Conclusions: We detected elevated serum levels of TNF-α and TNFR2 in KPro patients. Longitudinal studies are needed to establish TNF-α and TNFR2 as serum biomarkers related to KPro surgery. Abbreviations: BCVA: best corrected visual acuity; BMI: body mass index; CDR: cup-to-disc ratio; EDTA: ethylenediaminetetraacetic acid; ELISA: enzyme-linked immunosorbent assay; ESR: erythrocyte sedimentation rate; HVF: Humphrey visual field; IOP: intraocular pressure; KPro G: keratoprosthesis with glaucoma; KPro NoG: keratoprosthesis without glaucoma; KPro: keratoprosthesis; MD: mean deviation; NA: narrow angle; non-KPro: without keratoprosthesis; PACG: primary angle closure glaucoma; RNFL: retinal nerve fiber layer; TNF-α: tumor necrosis factor alpha; TNFR1: tumor necrosis factor receptor 1; TNFR2: tumor necrosis factor receptor 2.
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Affiliation(s)
- Eleftherios I Paschalis
- a Department of Ophthalmology , Harvard Medical School, Massachusetts Eye and Ear , Boston , MA , USA.,b Boston Keratoprosthesis Laboratory , Massachusetts Eye and Ear - Schepens Eye Research Institute, Harvard Medical School , Boston , MA , USA.,c Disruptive Technology Laboratory, Department of Ophthalmology , Massachusetts Eye and Ear, Harvard Medical School , Boston , MA , USA
| | - Elise V Taniguchi
- a Department of Ophthalmology , Harvard Medical School, Massachusetts Eye and Ear , Boston , MA , USA.,b Boston Keratoprosthesis Laboratory , Massachusetts Eye and Ear - Schepens Eye Research Institute, Harvard Medical School , Boston , MA , USA.,d Department of Ophthalmology , Universidade Federal de Sao Paulo , Sao Paulo , Brazil
| | - James Chodosh
- a Department of Ophthalmology , Harvard Medical School, Massachusetts Eye and Ear , Boston , MA , USA.,b Boston Keratoprosthesis Laboratory , Massachusetts Eye and Ear - Schepens Eye Research Institute, Harvard Medical School , Boston , MA , USA.,c Disruptive Technology Laboratory, Department of Ophthalmology , Massachusetts Eye and Ear, Harvard Medical School , Boston , MA , USA
| | - Louis R Pasquale
- e Department of Ophthalmology , Icahn School of Medicine, Mount Sinai Hospital , New York , NY , USA
| | - Kathryn Colby
- f Department of Ophthalmology , University of Chicago , Chicago , IL , USA
| | - Claes H Dohlman
- a Department of Ophthalmology , Harvard Medical School, Massachusetts Eye and Ear , Boston , MA , USA.,b Boston Keratoprosthesis Laboratory , Massachusetts Eye and Ear - Schepens Eye Research Institute, Harvard Medical School , Boston , MA , USA
| | - Lucy Q Shen
- a Department of Ophthalmology , Harvard Medical School, Massachusetts Eye and Ear , Boston , MA , USA
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26
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Choudhari NS, Chanda S, Khanna R, Senthil S, Garudadri CS. Diagnostic Accuracy of Van Herick Technique to Detect Pre-Disease States of Primary Angle Closure Glaucoma in a Resource Constraint Region. Ophthalmic Epidemiol 2019; 26:175-182. [PMID: 30616435 DOI: 10.1080/09286586.2018.1562083] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVES To critically evaluate diagnostic accuracy of the van Herick (vH) technique in detection of gonioscopically occludable angle in a rural population and to explore ways to improve accuracy of the technique Methods: The study cohort was formed by two-stage cluster random sampling. Peripheral anterior chamber depth grading was performed, using both traditional and modified (photographic comparison) vH techniques, under dark adapted and standard lighting conditions by a comprehensive ophthalmologist masked to the clinical features. The cut-off criterion for vH test was 25% of peripheral corneal thickness. The reference standard was dark room 4-mirror indentation gonioscopy performed by an experienced glaucoma specialist. This study adhered to the STARD guidelines for reporting diagnostic accuracy studies. RESULTS We studied 111 eyes of 111 participants. The median age was 62 years. The angle was occludable by gonioscopy in 69 (62%) eyes; 58 eyes were primary angle closure suspects and 11 were primary angle closure patients. The likelihood ratio (95% confidence interval (CI)) of the positive (LR+) and negative (LR‒) result by the traditional vH technique was 5.17 (2.43, 11) and 0.30 (0.20, 0.46), respectively. The LR+ by reducing and LR‒ by elevating the cut-off grade of the traditional vH technique were 9.4 (2.3, 37.4) and 0.08 (0.02, 0.31), respectively. The area under receiver operating characteristic curve did not differ significantly by photographic comparison or lighting condition (p = 0.13). CONCLUSIONS vH grading can be considered as a triage test before gonioscopy. The value of the vH technique to the diagnostic strategy is discussed.
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Affiliation(s)
- Nikhil S Choudhari
- a V S T Glaucoma Centre, Kallam Anji Reddy Campus , L V Prasad Eye Institute , Hyderabad , India.,b Edward and Soona Brown Eye Centre , L V Prasad Eye Institute , Sattenapalle , India
| | - Sanjay Chanda
- b Edward and Soona Brown Eye Centre , L V Prasad Eye Institute , Sattenapalle , India
| | - Rohit Khanna
- c Allen Foster Community Eye Health Research Centre , Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye care, L V Prasad Eye Institute , Hyderabad , India
| | - Sirisha Senthil
- a V S T Glaucoma Centre, Kallam Anji Reddy Campus , L V Prasad Eye Institute , Hyderabad , India
| | - Chandra Sekhar Garudadri
- a V S T Glaucoma Centre, Kallam Anji Reddy Campus , L V Prasad Eye Institute , Hyderabad , India
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27
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Xu BY, Pardeshi AA, Burkemper B, Richter GM, Lin SC, McKean-Cowdin R, Varma R. Quantitative Evaluation of Gonioscopic and EyeCam Assessments of Angle Dimensions Using Anterior Segment Optical Coherence Tomography. Transl Vis Sci Technol 2018; 7:33. [PMID: 30619653 PMCID: PMC6314106 DOI: 10.1167/tvst.7.6.33] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 10/17/2018] [Indexed: 12/16/2022] Open
Abstract
Purpose To evaluate the relationship between angle dimensions assessed by gonioscopy or EyeCam and anterior segment optical coherence tomography (AS-OCT). Methods Subjects aged 50 years or older were recruited from the Chinese American Eye Study (CHES). Each subject underwent a complete ocular exam, including gonioscopy, AS-OCT, and EyeCam. Angle closure was defined as three or more quadrants in which pigmented trabecular meshwork could not be visualized. Angle opening distance (AOD), angle recess area (ARA), trabecular iris space area (TISA), trabecular iris angle (TIA), and scleral spur angle (SSA) were measured in each AS-OCT image. Results 709 eyes (272 angle closure, 437 open angle) from 709 subjects were analyzed. Mean gonioscopy and EyeCam grades tended to increase as AS-OCT measurements increased. There were strong correlations overall between AS-OCT measurements and gonioscopy (r > 0.73) and EyeCam (r > 0.68) grades. However, correlations with AS-OCT measurements were weak for gonioscopy (r < 0.38) and EyeCam (r < to 0.27) among eyes with angle closure. Mean AS-OCT measurements differed for eyes with Shaffer grade 0 in all four quadrants among eyes with varying degrees of angle closure on gonioscopy (P < 0.01) but did not differ among eyes with varying degrees of angle closure on EyeCam (P > 0.27). Conclusions Angle assessments by gonioscopy and EyeCam are weakly related to angle dimensions in eyes with angle closure. Translational Relevance AS-OCT imaging raises concerns about current clinical methods that rely on direct visualization of ACA structures to assess the degree of angle closure.
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Affiliation(s)
- Benjamin Y Xu
- USC Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine at the University of Southern California, Los Angeles, CA, USA
| | - Anmol A Pardeshi
- USC Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine at the University of Southern California, Los Angeles, CA, USA
| | - Bruce Burkemper
- USC Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine at the University of Southern California, Los Angeles, CA, USA
| | - Grace M Richter
- USC Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine at the University of Southern California, Los Angeles, CA, USA
| | - Shan C Lin
- Beckman Vision Center, Department of Ophthalmology, University of California San Francisco, San Francisco, CA, USA
| | - Roberta McKean-Cowdin
- USC Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine at the University of Southern California, Los Angeles, CA, USA.,Department of Preventive Medicine, Keck School of Medicine at the University of Southern California, Los Angeles, CA, USA
| | - Rohit Varma
- USC Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine at the University of Southern California, Los Angeles, CA, USA.,Department of Preventive Medicine, Keck School of Medicine at the University of Southern California, Los Angeles, CA, USA
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28
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Paul C, Sengupta S, Banerjee S, Choudhury S. Angle closure glaucoma in rural and urban populations in eastern India-The Hooghly River Glaucoma Study. Indian J Ophthalmol 2018; 66:1285-1290. [PMID: 30127142 PMCID: PMC6113807 DOI: 10.4103/ijo.ijo_344_18] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Purpose: To estimate the prevalence, features, and associations of primary angle closure disease (PACD) in rural and urban populations from West Bengal in eastern India. Methods: This was a population-based cross-sectional study with two arms, rural and urban. The rural study area consisted of 28 contiguous villages from 13 gram panchayats in Balagarh Police Station, with rural base hospital at Dhobapara, Balagarh Police Station, in the village Kuliapara of Hooghly district. A tertiary eye hospital in central Kolkata was the urban study center. Individuals residing in the study area aged 40 years and above were included in this study using multistage random cluster sampling. All subjects underwent a detailed ophthalmic examination at our base hospitals including applanation tonometry, ultrasound pachymetry, gonioscopy, and frequency doubling technology perimetry. Data collected were analyzed using SPSS 13. Multiple logistic regressions were used to analyze risk factors for PACD. Results: A total of 7,408 and 7,248 subjects aged 40 years or older were enumerated from Hooghly district and Kolkata city, respectively. PACD was detected in 1.9% subjects in rural arm and 1.54% subjects in the urban arm (P < 0.001). In rural arm, 0.3% had PACS, 0.56% had PAC, and 1.03% had PACG. In urban arm, 0.22% had PACS, 0.35% had PAC, and 0.97% had PACG. Conclusion: The study concludes that higher age, higher CCT, and shorter axial length/presence of hyperopia are important independent predictors of ACD. ACD is more common in eastern India than previous estimates.
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Affiliation(s)
- Chandrima Paul
- Glaucoma Service, B B Eye Foundation, Kolkata, West Bengal, India
| | | | - Souvik Banerjee
- Glaucoma Service, B B Eye Foundation, Kolkata, West Bengal, India
| | - Sumit Choudhury
- Glaucoma Service, B B Eye Foundation, Kolkata, West Bengal, India
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Wang L, Huang W, Huang S, Zhang J, Guo X, Friedman DS, Foster PJ, He M. Ten-year incidence of primary angle closure in elderly Chinese: the Liwan Eye Study. Br J Ophthalmol 2018; 103:355-360. [PMID: 29777045 DOI: 10.1136/bjophthalmol-2017-311808] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Accepted: 04/13/2018] [Indexed: 11/03/2022]
Abstract
PURPOSE To determine the 10-year incidence of all forms of primary angle closure (PAC) in phakic eyes and its risk factors in an urban Chinese population aged 50 years and older. METHODS Survivors of 1405 baseline participants were invited to attend the 10-year follow-up visit in the Liwan Eye Study. Participants with established baseline angle closure, including primary angle closure suspects (PACS), PAC and primary angle closure glaucoma (PACG), or those who underwent bilateral cataract surgery during the 10-year period, as well as those who did not tolerate gonioscopic examinations, were excluded from this analysis. Incident PAC was present when those with open angles at baseline developed angle closure in any form in either eye during the 10-year period. RESULTS Among 791 participants who returned during the 10-year follow-up visit, 620 (78.4%) provided data on PAC incidence. The 10-year cumulative incidence of any forms of PAC was 20.5% (127/620, 95% CI 17.4% to 24.9%), including 16.9%, 2.4% and 1.1% with incident PACS, PAC and PACG in either eye, respectively. In multiple logistic regression, significant risk factors for incident angle closure were greater baseline lens thickness (OR=1.82 per mm, p=0.003), shallower anterior chamber depth (OR=3.18 per mm decreased, p=0.010) and narrower angle width (OR=1.63 per decreased angle width, p<0.0001). CONCLUSIONS Approximately one in five people aged 50 years and older developed some form of angle closure over a 10-year period. Small ocular dimensions and hyperopia at baseline were associated with the development of angle closure.
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Affiliation(s)
- Lanhua Wang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Wenyong Huang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Shengsong Huang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Jian Zhang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Xinxing Guo
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - David S Friedman
- Dana Center for Preventive Ophthalmology, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Paul J Foster
- NIHR Biomedical Research Centre at Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, UK
| | - Mingguang He
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China .,Centre for Eye Research Australia; Ophthalmology, Department of Surgery, University of Melbourne, Melbourne, Australia
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Li S, Shao M, Tang B, Zhang A, Cao W, Sun X. The association between serum uric acid and glaucoma severity in primary angle closure glaucoma: a retrospective case-control study. Oncotarget 2018; 8:2816-2824. [PMID: 27926530 PMCID: PMC5356844 DOI: 10.18632/oncotarget.13745] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Accepted: 11/23/2016] [Indexed: 12/13/2022] Open
Abstract
Uric acid (UA) is a major antioxidant molecule and has been hypothesized to have a protective effect on the central nervous system against oxidative damage. We prospectively investigated the serum concentration of UA in primary angle closure glaucoma (PACG), and explored the association between serum concentration of UA and the severity of PACG. Using a retrospective case-control study design, 886 PACG subjects and 994 control subjects who attended the Eye & ENT Hospital of Fudan University, were eligible for this study. Glaucoma severity was classified as mild (MD ≤ 6.00 dB), moderate (12 dB ≥ MD > 6 dB) and severe (MD > 12 dB) based on the MD (mean deviation). The levels of UA were significantly lower (p = 0.025) in PACG (0.286 ± 0.082 mmol/l) compared with control (0.295 ± 0.085 mmol/l). The mean serum UA levels were lowest in the severe group (0.281 ± 0.074 mmol/l) followed by moderate (0.282 ± 0.080 mmol/l) and mild (0.297 ± 0.090 mmol/l) with significant differences among the three groups (p = 0.032). In multivariate regression analysis, there was a significant negative correlation between UA level and vertical cup-disc ratio (B = −0.165, p = 0.035). Significantly lower serum UA concentration in PACG and its negative association with disease severity presented it as an important candidate in reaction to oxidative stress in glaucoma pathogenesis.
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Affiliation(s)
- Shengjie Li
- Department of Clinical Laboratory, Eye and ENT Hospital, Shanghai Medical College, Fudan University, Shangai, China
| | - Mingxi Shao
- Department of Clinical Laboratory, Eye and ENT Hospital, Shanghai Medical College, Fudan University, Shangai, China
| | - Binghua Tang
- Department of Clinical Laboratory, Eye and ENT Hospital, Shanghai Medical College, Fudan University, Shangai, China
| | - Aiping Zhang
- Department of Clinical Laboratory, Eye and ENT Hospital, Shanghai Medical College, Fudan University, Shangai, China
| | - Wenjun Cao
- Department of Clinical Laboratory, Eye and ENT Hospital, Shanghai Medical College, Fudan University, Shangai, China.,Department of Ophthalmology and Visual Science, Eye and ENT Hospital, Shanghai Medical College, Fudan University, Shangai, China
| | - Xinghuai Sun
- Department of Ophthalmology and Visual Science, Eye and ENT Hospital, Shanghai Medical College, Fudan University, Shangai, China.,State Key Laboratory of Medical Neurobiology, Institutes of Brain Science and Collaborative Innovation Center for Brain Science, Fudan University, Shanghai, China.,Key Laboratory of Myopia, Ministry of Health (Fudan University), Shangai, China.,Shanghai Key Laboratory of Visual Impairment and Restoration (Fudan University), Shangai, China
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Li S, Cao W, Han J, Tang B, Sun X. The diagnostic value of white blood cell, neutrophil, neutrophil-to-lymphocyte ratio, and lymphocyte-to-monocyte ratio in patients with primary angle closure glaucoma. Oncotarget 2017; 8:68984-68995. [PMID: 28978173 PMCID: PMC5620313 DOI: 10.18632/oncotarget.16571] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Accepted: 03/16/2017] [Indexed: 01/04/2023] Open
Abstract
Objective Inflammatory mechanisms may have a role in the pathogenesis of primary angle closure glaucoma (PACG). The objective of this study was to investigate the diagnostic value of white blood cell (WBC), neutrophil, neutrophil to lymphocyte ratio (NLR), and lymphocyte to monocyte ratio (LMR) in patients with PACG and its association with glaucoma severity. Method The study was retrospectively assessed in 771 consecutive PACG patients and 770 control subjects, laboratory parameters and clinical parameters were obtained from a medical data platform. Patients were divided into three groups with different severity based on perimetry, i.e. mild (mean deviation (MD) ≤6.00 dB), moderate (12 dB≥ MD>6 dB) and severe (MD>12 dB). We developed a nomogram to specifically identify individual patient’s risk. Results The mean levels of neutrophil, NLR and WBC was higher in PACG than control group, and lowest in the mild PACG group, followed by moderate PACG and severe PACG (p<0.05). The AUROC value of NLR and LMR was found to be 0.719, 0.699, respectively. Multiple linear regressions showed that there was a significant correlation between WBC and MD (B=0.151, p<0.001), neutrophil and MD (B=0.143, p=0.003), NLR and MD (B=0.144, p=0.001), LMR and MD (B=-0.100, p=0.034). Logistic regression analyses revealed that WBC (OR=1.208, 95%CI=1.179-1.238), neutrophil (OR=1.598, 95%CI=1.541-1.656), NLR (OR=2.313, 95%CI=2.200-2.431), and LMR (OR=0.682, 95%CI=0.666-0.699) were associated with PACG. Conclusion Our study suggested that WBC, neutrophil, NLR, and LMR was related with PACG, and NLR and LMR may be useful as biomarkers.
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Affiliation(s)
- Shengjie Li
- Department of Clinical Laboratory, Eye & ENT Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Wenjun Cao
- Department of Clinical Laboratory, Eye & ENT Hospital, Shanghai Medical College, Fudan University, Shanghai, China.,Department of Ophthalmology & Visual Science, Eye & ENT Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Jianping Han
- Department of Clinical Laboratory, Eye & ENT Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Binghua Tang
- Department of Clinical Laboratory, Eye & ENT Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Xinghuai Sun
- Department of Ophthalmology & Visual Science, Eye & ENT Hospital, Shanghai Medical College, Fudan University, Shanghai, China.,State Key Laboratory of Medical Neurobiology, Institutes of Brain Science and Collaborative Innovation Center for Brain Science, Fudan University, Shanghai, China.,Key Laboratory of Myopia, Ministry of Health, Fudan University, Shanghai, China.,Shanghai Key Laboratory of Visual Impairment and Restoration, Fudan University, Shanghai, China
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Baig N, Kam KW, Tham CCY. Managing Primary Angle Closure Glaucoma - The Role of Lens Extraction in this Era. Open Ophthalmol J 2016; 10:86-93. [PMID: 27014390 PMCID: PMC4780513 DOI: 10.2174/1874364101610010086] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2015] [Revised: 08/18/2015] [Accepted: 08/18/2015] [Indexed: 11/24/2022] Open
Abstract
Trabeculectomy has been the gold standard in reducing intraocular pressure (IOP) in glaucoma patients, no matter it is angle closure or open angle glaucoma. However in primary angle closure glaucoma, no matter the lens is cataractous or not, it is likely to be pathological, this thicker than usual lens, with or without a more anterior position, is often regarded as a strong contributing factor to angle closure. Lens extraction, no matter it is cataractous or clear, can theoretically eliminate this anatomical predisposing factor of angle closure, and thus IOP can be reduced. Based on recent results of a number of clinical trials, lens extraction alone or in combination with other IOP-lowering surgeries, may therefore play a more important role in the treating primary angle closure glaucoma. In cases when greater IOP-lowering effect is needed or if drug dependency has to be minimized, combined procedures, such as phacotrabeculectomy, can be considered, but the surgical risk can be higher than lens extraction alone.
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Affiliation(s)
- Nafees Baig
- Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, People's Republic of China; Hong Kong Eye Hospital, Kowloon, Hong Kong SAR, People's Republic of China
| | - Ka-Wai Kam
- Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, People's Republic of China; Prince of Wales Hospital, Shatin, N.T., Hong Kong SAR, People's Republic of China
| | - Clement C Y Tham
- Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, People's Republic of China; Prince of Wales Hospital, Shatin, N.T., Hong Kong SAR, People's Republic of China
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Liao L, Gong X, Lu M, Yan X, Xia Y, Wei Q. Associations of polymorphisms of rs1015213 with primary angle closure glaucoma-recent evidence and a meta-analysis. Int J Clin Exp Med 2015; 8:10804-10814. [PMID: 26379874 PMCID: PMC4565257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Accepted: 07/11/2015] [Indexed: 06/05/2023]
Abstract
BACKGROUND Primary angle closure glaucoma (PACG) has been thought to have a significantly genetic basis for a long time, and genome-wide association studies (GWAS) have identified various candidate genes including PCMTD1-ST18 rs1015213 as susceptibility loci. However, different results produced inconsistent results and make the conclusions controversial in some extent. Thus, we carried out a systematic review, attempting to summarize the recent evidence and determine the association of rs1015213 with PACG risk. METHODS A systematic literature search was conducted to identify all published studies on associations of rs1015213 (PCMTD1-ST18) polymorphism and PACG risk up to April 30, 2015. Selection of eligible studies was undertaken by two investigators according to inclusion criteria. Summary odds ratios (ORs) and 95% confidence intervals (95% CIs), as well as the pooled ocular biometric measures in different genotype or allele groups, were collected and analyzed. Heterogeneity was measured using the chi-square-based Q statistic test and I(2) metric. Publication bias of the included articles was evaluated using funnel plots. RESULTS 21 eligible studies were included, among them 15 studies with enough data to estimate OR were included for meta-analysis, with a total of 24764 subjects (4737 PACG patients and 20027 controls), including 19416 Asian subjects (4378 PACG patients and 15038 controls) and 5348 Caucasian subjects (359 PACG patients and 4989 controls). Low heterogeneity was detected among studies (for Asian subgroups P=0.80, I(2)=0%, for Caucasian subgroups P=0.78, I(2)=0%, for all groups, P=0.89, I(2)=0%), thus, only fixed-effects model was used in the meta-analysis. The results showed that the frequencies of the TT genotype of rs1015213 were significant higher in PACG group than the controls in Asians (OR=1.51, 95% CI 1.27-1.79, P<0.01) but not in Caucasians (OR=1.54, 95% CI 0.94-2.54, P=0.09). In sensitivity analysis the significance of the pooled OR remained almost the same when removing studies individually. Visual inspection of the funnel plots revealed no asymmetry. 6 studies were included for evaluating the association between rs1015213 polymorphism with axial length (AL) and anterior chamber depth (ACD), all of them showed that rs1015213 polymorphism is independent with AL (Shi, P=0.528; Day, P=0.74; Nongpiur, pooled P=0.067, respectively). 5 studies showed that rs1015213 polymorphism was significantly associated with a shallow ACD (P<0.05) but the other study did not support this result. CONCLUSION Our meta-analysis suggests that rs1015213 (TT genotype) is associated with PACG in Asian populations, but this association is not significant in Caucasian population and need more data. Some literatures also supported that rs1015213 polymorphism was associated with a shallow ACD but not with a short AL, however the evidences are not sufficient yet.
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Affiliation(s)
- Liang Liao
- Department of Ophthalmology, Dongfang Hospital, Beijing University of Chinese Medicine Beijing, China
| | - Xiaohong Gong
- Department of Ophthalmology, Dongfang Hospital, Beijing University of Chinese Medicine Beijing, China
| | - Ming Lu
- Department of Ophthalmology, Dongfang Hospital, Beijing University of Chinese Medicine Beijing, China
| | - Xiaoling Yan
- Department of Ophthalmology, Dongfang Hospital, Beijing University of Chinese Medicine Beijing, China
| | - Yanting Xia
- Department of Ophthalmology, Dongfang Hospital, Beijing University of Chinese Medicine Beijing, China
| | - Qiping Wei
- Department of Ophthalmology, Dongfang Hospital, Beijing University of Chinese Medicine Beijing, China
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Stefan C, Iliescu DA, Batras M, Timaru CM, De Simone A. PLATEAU IRIS--DIAGNOSIS AND TREATMENT. Rom J Ophthalmol 2015; 59:14-18. [PMID: 27373109 PMCID: PMC5729809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/15/2015] [Indexed: 06/06/2023] Open
Abstract
OBJECTIVES The objective of our study was to review the current knowledge on the diagnosis and treatment options of plateau iris configuration and syndrome. SYSTEMATIC REVIEW METHODOLOGY Relevant publications on plateau iris that were published until 2014. CONCLUSIONS Plateau iris syndrome is a form of primary angle closure glaucoma caused by a large or anteriorly positioned ciliary body that leads to mechanical obstruction of trabecular meshwork. This condition is most often found in younger patients. Plateau iris has been considered an abnormal anatomic variant of the iris that can be diagnosed on ultrasound biomicroscopy or optical coherence tomography of anterior segment. Patients with plateau iris syndrome can be recognized by the lack of response in angle opening after iridotomy. The treatment of choice in these cases is argon laser peripheral iridoplasty.
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Hong J, Yang Y, Wei A, Deng SX, Kong X, Chen J, Girard MJA, Mari JM, Xu J, Sun X. Schlemm's canal expands after trabeculectomy in patients with primary angle-closure glaucoma. Invest Ophthalmol Vis Sci 2014; 55:5637-42. [PMID: 25118266 DOI: 10.1167/iovs.14-14712] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
PURPOSE To evaluate the in vivo changes in the Schlemm's canal (SC) in patients with primary angle-closure glaucoma (PACG) after trabeculectomy using spectral-domain optical coherence tomography (SD-OCT). METHODS Forty eyes of 40 patients with PACG who underwent trabeculectomy were included. All participants underwent SD-OCT. The diameter and area of SC were examined and measured before and within 1 month after trabeculectomy. All SD-OCT images were processed using adaptive compensation algorithm to improve contrast and image quality. Multivariate linear regression analysis was performed for predictors of percentage change in the mean SC diameter and area. RESULTS The mean age of participants was 60.5 ± 14.6 years. Adaptive compensation significantly increased the percentage of sections in which SC was observable in the subjects studied from 52.5% (21/40) to 75.0% (30/40), which has acceptable intraobserver and interobserver repeatability. There was a significant increase in the SC diameter and area at the follow-up examination compared with the baseline value (SC diameter: 34.2 ± 6.2 μm vs. 28.4 ± 6.1 μm; SC area: 8117 ± 1942 μm(2) vs. 5200 ± 996 μm(2); all P < 0.001). After multivariate analysis, the only variable related to changes in SC was percentage change in IOP (SC diameter, P = 0.002; SC area, P < 0.001). In addition, the magnitude of the change in the SC area also correlated with angle opening distance at 750 μm from the scleral spur at baseline. CONCLUSIONS Expansion of SC was observed after trabeculectomy in PACG patients. The degree of SC expansion was related to the extent of the IOP decrease.
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Affiliation(s)
- Jiaxu Hong
- Department of Ophthalmology and Visual Science, Eye, Ear, Nose, and Throat Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yujing Yang
- Department of Ophthalmology and Visual Science, Eye, Ear, Nose, and Throat Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Anji Wei
- Department of Ophthalmology and Visual Science, Eye, Ear, Nose, and Throat Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Sophie X Deng
- Cornea Division, Jules Stein Eye Institute, University of California, Los Angeles, California, United States
| | - Xiangmei Kong
- Department of Ophthalmology and Visual Science, Eye, Ear, Nose, and Throat Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Junyi Chen
- Department of Ophthalmology and Visual Science, Eye, Ear, Nose, and Throat Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Michaël J A Girard
- In Vivo Biomechanics Laboratory, Department of Biomedical Engineering, National University of Singapore, Singapore Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | | | - Jianjiang Xu
- Department of Ophthalmology and Visual Science, Eye, Ear, Nose, and Throat Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Xinghuai Sun
- Department of Ophthalmology and Visual Science, Eye, Ear, Nose, and Throat Hospital, Shanghai Medical College, Fudan University, Shanghai, China State Key Laboratory of Medical Neurobiology, Institutes of Brain Science, Shanghai, China
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Huang X, Li M, Guo X, Li S, Xiao X, Jia X, Liu X, Zhang Q. Mutation analysis of seven known glaucoma-associated genes in Chinese patients with glaucoma. Invest Ophthalmol Vis Sci 2014; 55:3594-602. [PMID: 24825108 DOI: 10.1167/iovs.14-13927] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
PURPOSE To evaluate mutations in the MYOC, WDR36, OPTN, OPA1, NTF4, CYP1B1, and LTBP2 genes in a cohort of Chinese patients with primary glaucoma. METHODS Genomic DNA was prepared from 683 unrelated patients, including 50 with primary congenital glaucoma, 104 with juvenile open-angle glaucoma (JOAG), 186 with primary open-angle glaucoma (POAG), and 343 with primary angle-closure glaucoma (PACG). Mutations in the seven genes in 257 patients (36 with JOAG, 89 with POAG, and 132 with PACG) were initially analyzed by exome sequencing and then confirmed by Sanger sequencing. In addition, Sanger sequencing was used to detect MYOC mutations in the remaining 426 patients. RESULTS Exome sequencing identified 19 mutations (6 in MYOC, 9 in WDR36, 3 in OPA1, and 1 in OPTN) in 20 of 257 patients, including 4 patients with JOAG, 8 patients with POAG, and 8 patients with PACG. No mutation was detected in the other three genes. In addition, Sanger sequencing detected additional MYOC mutations in 5 of the remaining 426 patients, including 3 patients with JOAG and 2 patients with POAG. CONCLUSIONS Twenty-two mutations in MYOC, WDR36, OPA1, and OPTN were detected in 25 of the 683 patients with primary glaucoma, including nine MYOC mutations in 11 patients, nine WDR36 mutations in 11 patients, three OPA1 mutations in 3 patients, and one OPTN mutation in a patient who also carried a MYOC mutation. Eight mutations in MYOC, WDR36, and OPA1 in 8 of the 343 PACG patients are of uncertain significance and need to be analyzed further.
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Affiliation(s)
- Xiaobo Huang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Miaoling Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Xiangming Guo
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Shiqiang Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Xueshan Xiao
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Xiaoyun Jia
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Xing Liu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Qingjiong Zhang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
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Abu-Amero KK, Azad TA, Mousa A, Osman EA, Sultan T, Al-Obeidan SA. Association of SOD2 Mutation (c.47T > C) with Various Primary Angle Closure Glaucoma Clinical Indices. Ophthalmic Genet 2013; 36:180-3. [PMID: 24070129 DOI: 10.3109/13816810.2013.838276] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
We investigated whether the c.47T>C polymorphism (SNP rs4880) in the manganese superoxide dismutase (SOD2) gene is a risk factor for primary angle closure glaucoma (PACG) in the Saudi population. Among cases (n=139), the prevalence of various genotypes were 25.9%, 46.8% and 27.3% for T/T, C/T and C/C genotypes respectively. This trend was similar in the controls (n=403); 22.6%, 50.1% and 27.3% for T/T, C/T and C/C respectively. The differences in genotype distribution were not statistically significant (p=0.391 and 0.682 respectively). The minor allele frequency was 50.7% in cases and 52.4% in controls; this difference was not statistically significant (p=0.676). Investigating the potential association between this SOD2 polymorphism and different clinical indices, there was a statistically significant difference among different genotype groups in terms of three important clinical indices for PACG; Mean age at onset, duration of onset to and the mean LogMAR visual acuity (p=0.041, 0.018 and 0.033 respectively). The three markers are highly associated prognostic factors to diseases severity. If our results are proven in larger cohort and in various populations, then this SNP may have potentiality to be used as an indicator for PACG severity.
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Affiliation(s)
- Khaled K Abu-Amero
- Department of Ophthalmology, College of Medicine, King Saud University , Riyadh , Saudi Arabia and
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Abstract
Purpose To review the management regimes of acute primary angle closure (APAC) in two hospitals in Singapore, and to identify the incidence of and risk factors for progression to glaucomatous optic neuropathy. Methods We conducted a retrospective review of 40 patients from National University Hospital (NUH) and 52 patients from Singapore National Eye Centre (SNEC) who were diagnosed with APAC. Patients were treated with similar protocols of intensive medical therapy until laser peripheral iridotomy could be performed. In the event of failed medical treatment, patients at NUH only underwent laser iridoplasty. The 1-year outcomes were reviewed. Results The demographic features of patients and presenting intraocular pressures (IOP) were similar in both centers. More patients from NUH presented within 3 days of symptom onset, compared to those from SNEC (90.0% versus 71.2%, respectively) (P = 0.037). The mean ± standard deviation time to break the attack was 18.2 ± 32.9 hours at SNEC and 9.80 ± 10.6 hours at NUH (P = 0.11). The mean follow up duration was 18.8 ± 14.0 months. Nineteen patients (36.5%) from SNEC and six patients (22.5%) from NUH developed raised IOP (P = 0.032) within 1-year of the attack. Of these, glaucomatous optic neuropathy developed in thirteen patients (68.4%) from SNEC and all six patients (100%) from NUH. At final review, the mean IOP of the APAC eye was 14.8 ± 4.3 mmHg from SNEC and 13.4 ± 3.0 mmHg from NUH. There was no significant difference in final visual acuity or IOP between both groups. Conclusion Treatment strategies in both centers were effective in aborting an APAC attack. The development of raised IOP appears to be associated with a longer period of attack suggesting that greater urgency in aborting APAC attacks may entail better long term outcomes.
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Affiliation(s)
- Henrietta Ho
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
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Abstract
We report our recent experience of four eyes with spontaneous lens dislocation in four patients with no history of trauma or any systemic disease associated with zonular dialysis. Lens dislocation developed with 0.5 to 6 months following laser iridotomy. All patients were male and two eyes were complicated with acute primary angle closure glaucoma preoperatively. Case 1 showed bilateral lens dislocation, while cases 2 and 3 involved unilateral lens dislocation. Cases 2 and 3 showed lenses completely dislocated into the vitreous cavity. All cases needed lens removal and scleral fixation of intraocular lenses. Final visual acuity was 1.2 in all cases. We suspect that laser iridotomy may induce localized zonular dialysis that results in progressive zonular weakness, leading to lens dislocation.
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Affiliation(s)
- Tetsuya Mutoh
- Department of Ophthalmology, Dokkyo Medical University Koshigaya Hospital, Koshigaya City, Saitama, Japan ; Department of Ophthalmology, Boston University School of Medicine, Boston, MA, USA
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Ronnie G, Ve RS, Velumuri L, Asokan R, Vijaya L. Importance of population-based studies in clinical practice. Indian J Ophthalmol 2011; 59 Suppl:S11-8. [PMID: 21150021 PMCID: PMC3038516 DOI: 10.4103/0301-4738.73681] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2009] [Accepted: 10/13/2010] [Indexed: 11/30/2022] Open
Abstract
In the last decade, there have been reports on the prevalence of glaucoma from the Vellore Eye Survey, Andhra Pradesh Eye Diseases Survey, Aravind Comprehensive Eye Survey, Chennai Glaucoma Study and West Bengal Glaucoma Study. Population-based studies provide important information regarding the prevalence and risk factors for glaucoma. They also highlight regional differences in the prevalence of various types of glaucoma. It is possible to gather important insights regarding the number of persons affected with glaucoma and the proportion with undiagnosed disease. We reviewed the different population-based studies from India and compare their findings. The lacunae in ophthalmic care that can be inferred from these studies are identified and possible reasons and solutions are discussed. We also discuss the clinical relevance of the various findings, and how it reflects on clinical practice in the country. Since India has a significantly high disease burden, we examine the possibility of population-based screening for disease in the Indian context.
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Affiliation(s)
- George Ronnie
- Glaucoma Project, Vision Research Foundation, Sankara Nethralaya, Chennai, India
| | | | - Lokapavani Velumuri
- Glaucoma Project, Vision Research Foundation, Sankara Nethralaya, Chennai, India
| | - Rashima Asokan
- Glaucoma Project, Vision Research Foundation, Sankara Nethralaya, Chennai, India
| | - Lingam Vijaya
- Glaucoma Project, Vision Research Foundation, Sankara Nethralaya, Chennai, India
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Ichhpujani P, Pandav SS, Ramasubramanian A, Kaushik S. Profile of angle closure in a tertiary care center in north India. Indian J Ophthalmol 2010; 58:199-203. [PMID: 20413921 PMCID: PMC2886249 DOI: 10.4103/0301-4738.62643] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2009] [Accepted: 11/26/2009] [Indexed: 12/03/2022] Open
Abstract
PURPOSE To study the demographic and clinical profile of the types of primary angle closure patients presenting at a tertiary care center in North India. MATERIALS AND METHODS Clinic records of patients diagnosed as primary angle closure were reviewed. International Society of Geographical and Epidemiological Ophthalmology (ISGEO) classification scheme was used to categorize patients. Demographic and clinical data including prior management was collected and analyzed. Main Outcome measures were age, sex, symptomatology, best corrected visual acuity (BCVA), intraocular pressure (IOP), gonioscopy, optic disc assessment and visual field defects. Logistic regression model and receiver operating curve (ROC) were calculated for predictors of type of glaucoma. RESULTS Eight hundred and fourteen patients (1603 eyes; males: 380, females: 434) were diagnosed to have various subtypes of angle closure. Mean (+/-SD) age at presentation was significantly higher for males (57.57 +/- 11.62 years) as compared to females (53.64 +/- 10.67 years) ( P < 0001). Primary angle closure glaucoma (PACG) was most frequently diagnosed subtype (49.38%) followed by Primary angle closure (PAC) (39.68%) and Primary angle closure suspect (PACS) (10.93%) respectively. The three subtypes differed significantly among their mean IOP (on ANOVA, F = 14.04; P < 0001 using Greenhouse-Geisser correction). Univariate analysis was done to find significant predictors for the outcome of PACG. Logistic regression model and ROC containing the significant predictors yielded a very high AUC of 0.93 with strong discriminatory ability for PACG. CONCLUSION In our hospital-based study, the significant predictors for the outcome of PACG included male gender, diminution of vision, the presence of pain and worsening grades of BCVA. Nearly half of PACG presented with advanced disease. In spite of one-third of the patients being diagnosed as angle closure prior to referral, only 8.34% had iridotomy (laser or surgical) done.
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Affiliation(s)
- Parul Ichhpujani
- Department of Ophthalmology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Surinder S Pandav
- Department of Ophthalmology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Aparna Ramasubramanian
- Department of Ophthalmology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sushmita Kaushik
- Department of Ophthalmology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Nolan WP, Baasanhu J, Undraa A, Uranchimeg D, Ganzorig S, Johnson GJ. Screening for primary angle closure in Mongolia: a randomised controlled trial to determine whether screening and prophylactic treatment will reduce the incidence of primary angle closure glaucoma in an east Asian population. Br J Ophthalmol 2003; 87:271-4. [PMID: 12598435 PMCID: PMC1771551 DOI: 10.1136/bjo.87.3.271] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
AIM To describe the methods used and initial results of a prospective study designed to determine whether screening and prophylactic treatment will reduce the incidence of primary angle closure glaucoma (PACG) in Mongolia. METHODS A total of 4725 individuals aged 50 years and above were recruited to the study and randomised to intervention or control groups. All subjects had non-mydriatic optic disc examination. The intervention arm had measurement of anterior chamber depth (ACD) by A-scan ultrasound and intraocular pressure (IOP) with Tonopen. Gonioscopy was performed on test positive cases (ACD <2.53 mm or IOP >or=24 mm Hg either eye). Those with occludable angles were offered laser iridotomy. Primary outcome will be incidence of PACG at 5 year follow up. RESULTS Glaucoma was diagnosed in 128 (2.7%) subjects. Of the remaining 4597, 2293 were randomised to intervention. Intervention as allocated was received by 2280 (99.4%) individuals. 160 (23.4%) of 685 test positive cases had occludable angles, of which 156 were treated with iridotomy. CONCLUSIONS This trial is a further step in determining whether screening and prophylactic treatment for primary angle closure in east Asian populations will reduce the incidence of glaucoma.
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Affiliation(s)
- W P Nolan
- Department of Epidemiology and International Eye Health, Institute of Ophthalmology, London, UK.
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