Abstract
Purpose To investigate the serum changes of oxidative stress markers and the relationship between these factors and visual field (VF) progression in patients with primary angle closure glaucoma (PACG). Methods A case-control and a prospective cohort study. A total of 94 patients with PACG and 89 normal controls were enrolled. Furthermore, 94 PACG subjects were followed up for at least two years (once every six months). All participants were evaluated for serum levels of superoxide dismutase (SOD), total antioxidant status (TAS), hydrogen peroxide (H2O2), malondialdehyde (MDA), glutathione peroxidase, glutathione reductase, and detailed eye and systematic examination. Binary logistic regression analysis and Cox regression analysis were performed. Results The serum levels of SOD and TAS in the PACG group were significantly lower than those in the control group (p < 0.001). Meanwhile, PACG subjects had significantly higher levels of MDA and H2O2 than the normal control subjects (p < 0.001). Serum levels of TAS (OR = 0.773, 95%CI = 0.349 − 0.714, p < 0.001), SOD (OR = 0.975, 95%CI = 0.955 − 0.995, p < 0.001), MDA (OR = 1.155, 95%CI = 1.080 − 1.235, p < 0.001), and H2O2 (OR = 1.216, 95%CI = 1.142 − 1.295, p < 0.001) were independent risk/protective factors for PACG. TAS levels (HR = 0.041, 95%CI = 0.008–0.218, p < 0.001), SOD levels (HR = 0.983, 95%CI = 0.971–0.994, p = 0.003), and MDA levels (HR = 1.010, 95%CI = 1.001–1.018, p = 0.015) at baseline were associated with visual field progression. Kaplan–Meier curves reveal that patients with TAS < 0.95/SOD < 143/MDA > 12 had a significantly higher percentage of PACG progression (p < 0.05). Conclusions Decreased levels of TAS and SOD as well as increased levels of MDA at baseline were associated with VF progression in patients with PACG. These findings suggest that oxidative stress was involved in the onset and development of PACG.
Highlights
Primary glaucoma represents a group of diseases defined by characteristically elevated intraocular pressure (IOP), visual dysfunction, and optic nerve head cupping and is one of the major causes of irreversible blindness worldwide [1, 2]
After adjusting for age, gender, body mass index (BMI), systolic blood pressure (SBP), diastolic blood pressure (DBP), smoking, drinking, the number of topical glaucoma medications, and IOP, the analyses revealed that total antioxidant status (TAS) (OR = 0:773, 95%CI = 0:349 – 0:714, p < 0:001), superoxide dismutase (SOD) (OR = 0:975, 95%CI = 0:955 – 0:995, p < 0:001), MDA (OR = 1:155, 95%CI = 1:080 – 1:235, p < 0:001), and H2O2 (OR = 1:216, 95%CI = 1:142 – 1:295, p < 0:001) were independent risk/protective factors for primary angle closure glaucoma (PACG)
Engin et al [28] reported that the serum levels of TAS, SOD, and glutathione peroxidase (GPX) decreased and serum levels of MDA increased in patients with glaucoma, which provides compelling evidence for imbalance in the oxidative stress system in the peripheral blood of glaucoma
Summary
Primary glaucoma represents a group of diseases defined by characteristically elevated intraocular pressure (IOP), visual dysfunction, and optic nerve head cupping and is one of the major causes of irreversible blindness worldwide [1, 2]. Adav et al [6] suggested that the critical mediators of oxygen homeostasis and neuronal function in the aqueous humor were significantly dysregulated in disease, strongly implicating oxidative stress responses in PACG-associated nerve damage. Our previous study reported that the serum level of uric acid, a major antioxidant molecule, was significantly lower in PACG [11] and POAG [12] subjects than that in the control subjects. These results may suggest that evaluating oxidative stress may help in understanding the course of PACG, and oxidative stress damage might be a relevant target for both glaucoma prevention and therapy
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