Development Of Primary Angle Closure Glaucoma Research Articles

Технические трудности выполнения миниинвазивной хирургии катаракты при утолщенном хрусталике в глазах с короткой переднезадней осью

Purpose. To study the technical features of cataract phacoemulsification in in eye with short axial length. Material and methods. 18 eyes with an increased risk of primary angle-closure glaucoma (PACG) (18 patients, age: 46–80 years). In 14 eyes – clear lens; 4 eyes – initial cataract. Phacoemulsification for prophylaxis of development of PACG is carried out. Features of surgical technique and complication are revealed. The term of observation was 12–36 months. Results. Improvement of anatomic parameters of eye globe and visual functions is reached; PACG did not develop at anybody in remote period of observation. Conclusion. High performance and safety phacoemulsification of transparent crystalline lens for prophylaxis of risk of development of an acute attack of PACG in eyes with the short axial lengths is proved. Keywords: hyperopia, angle-closure glaucoma, phacoemulsification, complications.

Clinical and Genetic Analysis of Retinitis Pigmentosa with Primary Angle Closure Glaucoma in the Chinese Population

Purpose Retinitis pigmentosa (RP) constitutes a class of common inherited retinal dystrophies. Patients with RP and comorbid primary angle-closure glaucoma (PACG) have been described, but the relationship between the diseases remains unclear. This study investigated the clinical and genetic characteristics of Chinese patients with RP and comorbid PACG. Methods Of 1356 patients with RP, we analyzed the genetic features of 39 RP patients with PACG using next-generation sequencing and reviewed their clinical characteristics. Results In total, 18 patients with acute PACG and 21 patients with chronic PACG were included in this study; their age at examination was 50.54 ± 12.99 years (range, 25.0–71.0 years), and their age at PACG onset was 46.04 ± 14.50 years (range, 24.9–68.0 years). Additionally, the mean lens thickness (LT) was 4.49 ± 0.44 μm, and the mean axial length (AL) was 22.63 ± 1.17 mm. Notably, the prevalence of PACG in patients with RP was 2.88%; this was higher than the prevalence in the general population. This could be explained by nanophthalmos, thickened lentis, ectopia lentis, or zonular insufficiency. Furthermore, patients with a shorter AL, a greater LT, iridociliary cysts, or nanophthalmos exhibited earlier development of PACG. Overall, 30 disease-causing variants spanning 17 genes were identified in 56.41% of the patients, and PRPH2 was the most common mutation gene. Conclusions Our findings revealed that there is a strong association between RP and PACG. Furthermore, intraocular pressure (IOP) should be measured in patients with RP to protect them from the aggravated damage of an elevated IOP.

Efficacy of Laser Iridotomy in Primary Angle Closure Suspects and Primary Angle Closure Glaucoma

Addressing the issue of a closed angle of the anterior chamber plays a key role in preventing the development of angleclosure glaucoma.The purpose: to compare the efficacy of Laser Peripheral Iridotomy (LPI) at the stage of primary angle closure suspects (PACs) with LPI carried out at the initial stage of primary angle-closure glaucoma (PACG).Materials and methods. A clinical case of a primary angle closed disease (PACD) in a patient with PACs after LPI in the right eye and with PACG after LPI, selective laser trabeculoplasty (SLT) and phacoemulsification with intraocular lens implantation in the left eye is presented. A detailed examination was performed in dynamics, including methods of visualization of the anterior and posterior segments of the eye.Results. After 2.5 years, the anterior chamber angle in the right eye retained an expanded profile after LPI (up to 30°), no signs of PACG development were recorded. On the left eye, the anterior chamber angle remained closed (9°) with an IOP of 24 mm Hg at the maximum hypotensive therapy with eye drops. Despite the absence of progression of glaucomatous optic neuropathy in both eyes, the risk of the transition from the initial stage to the moderate and advanced stage of PACG in the left eye still remains due to the presence of goniosynechia and possible fluctuations of intraocular pressure.Conclusion. LPI is more effective at the stage of PACs and its implementation is advisable in order to prevent the development of PACG.

Viscoelastic properties of the iris in different types of glaucoma

Introduction. The iris is involved in maintaining the ocular hydrodynamic homeostasis as one of the elements of the anterior chamber angle of the eye. From there, the iris is one of the parts of its drainage area. The anterior chamber angle’s structure can predispose to an increase in intraocular pressure and thereby provoke the development of primary angle-closure glaucoma, a disease accompanied by clogging of the drainage area of the eye and, accordingly, an increase in intraocular pressure.Objective. To analyse the viscoelastic properties of the iris in primary angle-closure glaucoma and primary open-angle glaucoma.Materials and methods. The study material was a fragment of the iris obtained through iridectomy in the course of sinus trabeculectomy, which is considered the treatment for glaucoma surgery. A total of 43 samples (43 patients) were obtained and analysed, with 20 samples obtained from patients with primary angle-closure glaucoma (group 1), and 23 samples from patients with primary open-angle glaucoma (group 2). A standard ophthalmological examination, which included visometry, autorefractometry, tonometry, biomicroscopy, and indirect ophthalmoscopy, was carried out. The special examination included static perimetry, gonioscopy, ultrasound biomicroscopy or optical coherence tomography of the anterior chamber angle, optical coherence tomography of the disk of optic nerve.Results and discussion. The avascular part of the stroma (designated by us as S) is the most rigid part of the iris, according to the study. It is characterized by the greatest efforts of the viscous dynamic resistance to the indenter (0.4–2.0 gf/мм2 × S), as well as the maximum integral tensile strength (up to 4.9 × 10-2 N). The inner (vascular) part of the stroma has the lowest dynamic viscosity, according to this study.Conclusion. The samples vary enormously both in the biomechanical characteristics and relative thickness of this layer. It was observed that this biomechanically incompetent structure completely collapses and ceases to exist in partial dehydration of the sample.

Features Local Interlacing Status of Elderly Patients with Primary Angle-Closure Glaucoma

An increased share of the elderly in the structure of modern society, along with other causes and risk factors, is accompanied by the growing the incidence of glaucoma. According to international research in the world by 2020 it is predicted that glaucoma patients will increase to 80 million. Among the elderly, glaucoma is a common pathology, the development of which is associated with local disorders of the interleukin profile. However, the features of the latter in patients with primary closed-angle glaucoma in the elderly have not been studied. The purpose of this work is to identify the features and informativeness of local interleukin profile indicators in elderly patients with primary angle — closure glaucoma. The study included 58 patients with primary angle-closure glaucoma of stage II, who made up the main group, aged 60–74 years with a median of 70.1 ± 2.5 years. All patients underwent a comprehensive ophthalmological examination. The diagnosis of primary angle-closure glaucoma was established in accordance with the requirements of the National glaucoma guidelines. The control group consisted of 27 elderly people aged 60 to 74 years with a median of 68.7 ± 2.1 years without signs and manifestations of primary angle-closure glaucoma, who also underwent a comprehensive ophthalmological examination. Changes in proinflammatory interleukins at the local level in the development of primary angle-closure glaucoma are accompanied by a significant increase in their content in all cases. On the contrary, changes in anti-inflammatory interleukins in the lacrimal fluid in patients with the considered ophthalmological pathology are characterized by a significant inhibition of their production. IL-10 are characterized by the most significant decrease at the local level and it is less related to IL-4. Local interlacing profile of patients with primary angle-closure glaucoma elderly are characterized by increased level in the tear fluid of anti-inflammatory IL-2, IL-17, IL-8 and lower production of anti-inflammatory IL-10. These local interleukins have the greatest informative value, which is of scientific and practical significance for identifying new mechanisms of development, diagnostics and justification of selective immunotropic therapy of the pathology in question.

Relationship between Oxidative Stress Biomarkers and Visual Field Progression in Patients with Primary Angle Closure Glaucoma.

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.

Effectiveness of the system for predicting the risk of developing an acute angle closure glaucoma attack

To assess the effectiveness of predicting the development of PACG in eyes with short anterior-posterior axis. The study included 69 patients (90 eyes) aged 46 to 80 years with short anterior-posterior axis. We used our own mathematical formulas for calculating the risk of PACG development. According to these formulas, two groups of patients with high risk of PACG were selected. Patients of the main group underwent cataract phacoemulsification for preventive purposes, while patients of the comparison group did not undergo any operative treatment. In the long-term, PACG did not develop in the patients of the main group. Patients of the comparison group refused to undergo cataract phacoemulsification, and had PACG develop in 38% of cases in the long-term follow-up. The high efficiency of the developed screening model for estimating the risk of PACG developing in eyes with short anterior-posterior axis has been proved. Preventive cataract phacoemulsification in the eyes with a high risk of PACG development in all cases helped to avoid it, retaining and even improving visual functions.

Inflammatory cytokine profiles in eyes with primary angle-closure glaucoma.

Acute primary angle-closure (APAC) eyes show an early ‘acute inflammatory’ condition, while the inflammation condition has not been fully elucidated in the development of primary angle-closure glaucoma (PACG). To evaluate the roles of inflammatory cytokines in the pathogenesis of PACG, this cross-sectional study involved 40 eyes of 32 PACG patients who required trabeculectomy and 24 eyes of 24 patients who required cataract surgery. The aqueous humor samples were collected at the time of surgery. Fifteen inflammatory cytokines were detected using the multiplex bead immunoassay technique, and the clinical information was recorded for the correlation analysis. Eight of the 15 cytokines were all detectable in both groups, including granulocyte colony-stimulating factor (G-CSF), interleukin (IL)-6, IL-8, monocyte chemotactic protein (MCP)-1, MCP-3, macrophage-derived chemokine (MDC), macrophage inflammatory protein (MIP)-1β, and vascular endothelial growth factor (VEGF). When compared with the cataract patients, the MCP-3, MDC, and VEGF levels were elevated in the PACG patients, while the MCP-1 and MIP-1β levels were decreased. However, the G-CSF, IL-6, and IL-8 levels were similar between the two groups. The MCP-1 concentration was elevated accordingly as the disease progressed in the PACG patients. Our results suggest the PACG eyes retained a ‘mild inflammation’ condition in the aqueous humor, and MCP-1 may play an important role in the progression of this disease.

Association between coagulation function and patients with primary angle closure glaucoma: a 5-year retrospective case–control study

ObjectiveTo evaluate the association between coagulation function and patients with primary angle closure glaucoma (PACG).DesignA retrospective, hospital-based, case–control study.SettingShanghai, China.ParticipantsA total of 1778 subjects were recruited from the Eye &...

Evaluation of potential risk factors for development of primary angle-closure glaucoma in Bouviers des Flandres.

OBJECTIVE To evaluate potential risk factors for development of primary angle-closure glaucoma (PACG) in Bouviers des Flandres. DESIGN Prospective, observational study. ANIMALS 98 Bouviers des Flandres. PROCEDURES All dogs underwent slit-lamp biomicroscopy, indirect ophthalmoscopy, gonioscopy, applanation tonometry, streak retinoscopy, and A-scan, B-scan, and high-resolution ultrasonography. Iridocorneal angles and degree of pectinate ligament dysplasia sheeting were graded, and an angle index was mathematically derived for each eye on the basis of these values. Ciliary clefts evaluated by high-resolution ultrasonography were classified as open, narrow, or closed. Owners were contacted by telephone 7 to 9 years after the initial examination to determine whether dogs had a subsequent diagnosis of PACG. Relationships between previously recorded variables and the development of PACG were evaluated by logistic regression methods. Available pedigrees were reviewed to assess genetic relationships among affected dogs. RESULTS 9 of 92 (9.8%) dogs with follow-up information available developed PACG. An angle index < 1 and presence of a narrow or closed ciliary cleft in 1 or both eyes were each significantly associated with development of PACG. Odds of developing PACG for dogs with an angle index < 1 (indicating marked reduction in outflow capacity through the iridocorneal angle), a narrow or closed ciliary cleft in > 1 eye, or both findings were 13, 20, and 28 times those for dogs that did not have these findings, respectively. All dogs that developed PACG shared 1 common male sire or grandsire. CONCLUSIONS AND CLINICAL RELEVANCE Several anatomic factors were significant risk factors for development of PACG in this population of dogs. Results also suggested a genetic component for the disease.

Evaluation of the Association Between Common Genetic Variants Near the ABCA1 Gene and Primary Angle Closure Glaucoma in a Han Chinese Population.

Recently, three large genome-wide association studies have identified multiple variants associated with primary open angle glaucoma (POAG) near the ABCA1 gene. Considering that POAG and primary angle closure glaucoma (PACG) share many similar clinical manifestations, the present study was conducted to investigate whether these genetic variants were also associated with PACG in a Han Chinese population. A case-control association study of 1122 cases (PACG/PAC) and 1311 normal, matched controls was undertaken. Seven single-nucleotide polymorphisms (SNPs) near the ABCA1 gene, including rs2422493, rs2487042, rs2472496, rs2472493, rs2487032, rs2472459, and rs2472519, were genotyped. Genotype and allele frequencies were assessed using χ² tests. Linkage disequilibrium (LD) structure was analyzed by computer software. Among the SNPs genotyped, no association was observed between these SNPs and PACG. However, we discovered that two haplotypes, CATTTAC (corrected P = 0.048) and CGCCCGC (corrected P = 0.048), remained significantly associated with PACG/PAC after Bonferroni correction. Subjects with the CATTTAC haplotype have a 1.71-fold increased possibility of having PACG/PAC, whereas subjects with the CGCCCGC haplotype have 0.47-fold decreased possibility of developing PACG. Our findings suggest that the genetic backgrounds of PACG and POAG might be different. However, whether or not ABCA1 plays a role in the development of PACG is still not made certain by this study. Thus, further research is needed to find the role of ABCA1 in the progress of PACG.

Genetic associations in PLEKHA7 and COL11A1 with primary angle closure glaucoma: a meta-analysis.

Single nucleotide polymorphisms (SNPs) rs11024102 in PLEKHA7 and rs3753841 in COL11A1 were identified to be associated with primary angle closure glaucoma (PACG) by a recent large genome-wide association study. This present study is to evaluate the association of PLEKHA7 rs11024102 and COL11A1 rs3753841 with PACG. A systematic review and meta-analysis. A total of 25 271 subjects (4895 PACG patients and 20 376 controls) in different ethnicities were tested for PLEKHA7 rs11024102 and COL11A1 rs3753841. A comprehensive literature search was conducted on studies published up to July 2014. Summary odds ratios (ORs) and 95% confidence intervals were analysed. Publication bias of the included articles was evaluated using funnel plots and Egger's test. OR for the effects of PLEKHA7 rs11024102 and COL11A1 rs3753841 on PACG risk. Four eligible articles were included in this study for meta-analysis. The overall result showed that SNPs rs11024102 and rs3753841 were statistically associated with PACG (P < 0.001) in fixed-effects model. Stratified analyses showed that the association of PLEKHA7 rs11024102 and COL11A1 rs3753841 with PACG was statistically significant in Asian population (including South Indian cohort) (P < 0.001). In Caucasian population, significant association of COL11A1 rs3753841 with PACG was detected (P = 0.004), but PLEKHA7 rs11024102 did not show any association with PACG (P = 0.140). This meta-analysis suggests that PLEKHA7 rs11024102 is associated with PACG in Asian population and COL11A1 rs3753841 has a genetic association with the development of PACG both in Caucasian and Asian populations.

The Evaluation of the Oxidative Stress Parameters in Patients with Primary Angle-Closure Glaucoma

ObjectiveTo clarify the presence of oxidative stress in patients with primary angle-closure glaucoma (PACG) and to investigate the relationship between oxidative stress and PACG.MethodsFifty patients with primary angle-closure glaucoma and fifty healthy controls of matched age and gender were included in the study prospectively. Serum samples were obtained to detect the oxidation degradation products malondialdehyde (MDA), conjugated diene (CD), 4-hydroxynonenal (4-HNE), advanced oxidation protein products (AOPP), protein carbonyl (PC), ischemia-modified albumin (IMA) and 8-hydroxydeoxyguanosin (8-OHdG).ResultsThe concentration of MDA and CD in PACG patients was significantly higher than those of the control subjects (P<0.05, P<0.01). The serum 4-HNE concentrations were increased in PACG patients, but the differences with those of the healthy controls were not statistically significant. Compared to normal subjects, there was significant higher in serum AOPP and PC in PACG patients (P<0.01). PACG patients had higher levels of 8-OHdG in serum with respect to the comparative group of normal subjects (P<0.01). When plasma IMA levels in the PACG group were compared with those in the control group, significant increases in IMA were observed in the former (P<0.05).ConclusionsOur study demonstrated that IMA is a new biomarker available for assessing oxidative stress in PCAG. Oxidative stress is an important risk factor in the development of primary angle-closure glaucoma. Increased levels of oxidative stress products may be associated with primary angle-closure glaucoma.

Outcomes following acute primary angle closure in an Asian population

Data regarding development of primary angle closure glaucoma (PACG) following acute primary angle closure (APAC) is conflicting. This study looks at outcomes after an APAC episode with a secondary aim to identify any risk factors that could predict progression to PACG. This is a retrospective review of the charts of consecutive patients who were diagnosed with APAC from December 2003 to June 2006. All were treated in a standard manner with initial intensive medical therapy or laser iridoplasty followed by early laser peripheral iridotomy within 24 h of presentation. Forty-two eyes of 41 patients were analysed. The mean follow-up period was 27.3 +/- 16.2 months. Nine eyes (21.4%) developed an increase in intraocular pressure (IOP) within a mean of 11.9 months (median 5 months) after resolution of APAC. Eight eyes went on to have trabeculectomy or glaucoma drainage device. At final follow up, the mean IOP of attack eye was 13.3 +/- 2.92 mmHg. None of the eyes, including those that underwent surgery, required topical medication to control IOP. Thirty-eight eyes (90.5%) have BCVA of 6/6 to 6/12. The duration of symptoms before presentation (P = 0.00) and duration taken to abort the acute attack (P = 0.01) were found to be significantly associated with development of PACG. The results of this study suggest that outcomes following successful treatment of APAC may not be as poor as described previously. Early aggressive management of the acute episode may have a role to play in preventing development of PACG after APAC.