Diagnosis Of Primary Open-angle Glaucoma Research Articles

Serum Brain-Derived Neurotrophic Factor in Glaucoma Patients in Japan: An Observational Study.

The aim of this study was to measure serum levels of brain-derived neurotrophic factor (BDNF) in Japanese patients with primary open angle glaucoma (POAG) and normal tension glaucoma (NTG). This was a prospective observational study of serum BDNF levels in 78 patients who underwent cataract surgery or trabeculectomy (27 glaucoma patients and 51 non-glaucoma cataract patients as controls). Patient age was 68.8 ± 11.1 years (mean ± standard deviation; range 35-86 years). The numbers of patients with POAG and NTG were 16 and 11, respectively. POAG was diagnosed by intraocular pressure measurement, gonioscopy, optic nerve head change, and presence of a visual field defect. Serum BDNF concentration was significantly lower in the glaucoma group (including both POAG and NTG) than in the control group (7.2 ± 3.6 ng/mL vs. 12.2 ± 9.3 ng/mL, p=0.004). Serum BDNF concentration was lower in early glaucoma than in moderate glaucoma. There was no correlation between serum BDNF concentration and age. When patients with NTG and POAG were compared, serum BDNF concentration was lower in the former. Serum BDNF concentration was not significantly correlated with glaucoma parameters, including optical coherence tomography and visual field defects. This is the first study to investigate serum BDNF concentration in glaucoma patients in Japan. Future studies should evaluate the role of BDNF as a potential biomarker of glaucoma.

Knowledge of open angle glaucoma questionnaire: Design and validation in Spanish-speaking patients of Peru

Abstract Objective To design and validate a questionnaire on the knowledge of primary open-angle glaucoma (POAG) in Spanish-speaking patients. Methods An observational study was conducted on adults with diagnosis of POAG and who received outpatient medical care in a national reference health care institute of Peru. The questionnaire was based on a literature review and expert judgment. A pilot study was carried out on 60 patients. The items were classified and weighted according to the expert judgment. The final questionnaire was completed by 314 patients and its overall score was scaled by tertiles. Results A total of 72 items were found by primary searching. The initial questionnaire was made up of 20 items, which was tested in a pilot study. A total of 14 items were selected that were then classified into three weighted domains: risk factors (10 %), clinical aspects (36 %), and treatment (54 %). The questionnaire has a score range from 0 to 100 points (lowest to highest level). In patients, the mean score was 62.6 ± 14.1. The overall score was classified into three categories of knowledge level: low (0–55 points), medium (56–69 points), and high (70–100 points). Conclusions The questionnaire provides evidence of validity to assess knowledge of POAG in Peruvian Spanish-speaking patients.

A Data Mining Metabolomics Exploration of Glaucoma.

Glaucoma is an age related disease characterized by the progressive loss of retinal ganglion cells, which are the neurons that transduce the visual information from the retina to the brain. It is the leading cause of irreversible blindness worldwide. To gain further insights into primary open-angle glaucoma (POAG) pathophysiology, we performed a non-targeted metabolomics analysis on the plasma from POAG patients (n = 34) and age- and sex-matched controls (n = 30). We investigated the differential signature of POAG plasma compared to controls, using liquid chromatography coupled to high resolution mass spectrometry (LC-HRMS). A data mining strategy, combining a filtering method with threshold criterion, a wrapper method with iterative selection, and an embedded method with penalization constraint, was used. These strategies are most often used separately in metabolomics studies, with each of them having their own limitations. We opted for a synergistic approach as a mean to unravel the most relevant metabolomics signature. We identified a set of nine metabolites, namely: nicotinamide, hypoxanthine, xanthine, and 1-methyl-6,7-dihydroxy-1,2,3,4-tetrahydroisoquinoline with decreased concentrations and N-acetyl-L-Leucine, arginine, RAC-glycerol 1-myristate, 1-oleoyl-RAC-glycerol, cystathionine with increased concentrations in POAG; the modification of nicotinamide, N-acetyl-L-Leucine, and arginine concentrations being the most discriminant. Our findings open up therapeutic perspectives for the diagnosis and treatment of POAG.

Morphologic Analysis of Peripapillary Retinal Arteriole Using Adaptive Optics in Primary Open-angle Glaucoma.

The purpose of this study was to better understand the role of vascular risk factors in the pathogenesis of primary open-angle glaucoma (POAG), a detailed analysis of retinal arterial wall thickness is needed. The purpose of the present study was to make a morphologic analysis of peripapillary arteriole in POAG using adaptive optics (AO) technology. We included otherwise healthy subjects with an isolated confirmed diagnosis of bilateral POAG. Patients' clinical characteristics were noted. AO imaging followed by a complete ophthalmic examination was performed. A single operator masked to clinical data performed 5 measurements at different locations of each analyzed vessel. For each location, lumen diameter and wall thickness were measured. Total diameter, wall-to-lumen ratio (WLR), and whole cross-sectional area were calculated. Lumen diameter and total diameter were significantly lower in the glaucoma group (n=31) than in the control group (n=29): [median (interquartile ranges)] 88.3 (82.6-99.2) versus 102.3 (87-113.1) (P=0.03) and 121.1 (109.3-130.5) versus 134.4 (112.7-144.4), respectively (P=0.015). Wall thickness, WLR, and whole cross-sectional area were not significantly different. Apart from a significantly higher WLR in subjects with reported high cholesterol levels, we did not observe any correlation between patients' clinical characteristics and any of the parameters. We observed in POAG a narrowing of the arteriolar lumen without modification of the vessel wall thickness. To date, it is the first time that these data are obtained using AO. This suggests that the vascular risk factor in POAG only reduces the vascular caliber without inducing any patent atherosclerosis of the retinal arterial wall.

Clinical Characteristics of Patients Newly Diagnosed with Primary Open Angle Glaucoma at the Yaoundé Central Hospital-Cameroon

Objective: To describe the clinical characteristics of patients newly diagnosed with primary open angle glaucoma (POAG) in a tertiary hospital. Methods: A review of the medical records of patients newly diagnosed with POAG between 1st January 2016 and 31st January 2018 was done. POAG diagnosis was based on the presence of any two of the following: elevated intraocular pressure (IOP), glaucomatous optic nerve changes and characteristic visual field defects in the presence of a normal angle on gonioscopy. Blindness was defined as corrected distant visual acuity (CDVA) of 0.05. Results: Amongst the 10 400 new patients seen during the study period, 96 were diagnosed with POAG (0.92%). The male: female sex ratio was 1.5. The mean age was 49.1 ± 19.9 years. Family history of glaucoma was present in 11 patients (11.46%). The mean cup/disc ratio was 0.6 ± 0.2. Glaucomarelated blindness was unilateral in 5.2% of patients (n=5). No patient had bilateral blindness. Unilateral J Ophthalmol Res 2019; 2 (3): 050-056 DOI: 10.26502/fjor.2644-00240011 Journal of Ophthalmology and Research 2 and bilateral severe visual impairment were present respectively in 10.42% and 33.33% of cases. Conclusion: Late presentation is common in POAG with severe cupping and moderate to advanced visual field defects. Unilateral blindness or severe visual impairment is present in 38.5% of cases. Information and screening should be put in place to encourage early diagnosis which will reduce the burden of glaucoma-related blindness.

Comparison of structural and functional tests in primary open angle glaucoma.

Purpose:To comparatively analyze the structural and functional tests used in the diagnosis and follow-up of glaucoma.Methods:Eighty eyes of 40 patients with primary open angle glaucoma (POAG) and 46 eyes of 23 healthy individuals were included in the study. Transient pattern electroretinography (PERG), steady-state PERG (ssPERG), computerized visual field (VF) screening, and examination of retinal nerve fiber layer (RNFL) and macular thickness on optical coherence tomography (OCT) were undertaken. The results were compared between the groups.Results:80 eyes belonging to 40 patients with a diagnosis of POAG (23 female, 17 male) (18 mild 22 moderate POAG) with a mean of 57.37 (±8.6) years, and 46 eyes of 23 healthy individuals (14 female, 9 male) with a mean age of 55.30 (±8.09) years were included in the study. PERG P50 and N95 and ssPERG latency revealed a significant delay in the POAG group. When the wave amplitudes were examined, they were found to be significantly lower in both PERG and sSPERG tests for the POAG group, but the results were more pronounced in ssPERG. The latency values of PERG and ssPERG tests were not significantly correlated with any of the parameters of the remaining tests. However, the amplitude values of these tests had a positive correlation with the mean deviation value and negative correlation with the pattern standard deviation value of VF. All associated parameters were significant for the amplitude value of the ssPERG test.Conclusion:For the proper management of glaucoma, rather than approaching damage simply as the loss of retinal ganglion cells or the neuroretinal rim, it is necessary to focus on the ongoing anatomical and functional relationship and evaluate structural and functional tests together. In addition, ssPERG test, which is not widely adopted in routine practice, provides valuable information and is significantly correlated with OCT parameters.

Relationship between optic nerve head topography and nerve fiber layer thickness with central corneal thickness in patients with primary open-angle glaucoma

Introduction/Objective. In patients with primary open-angle glaucoma (POAG) we explored the relationship between the optic nerve head (ONH) topography parameters and the retinal nerve fiber layer (RNFL) thickness with the central corneal thickness (CCT). Methods. This retrospective study included 97 patients (97 eyes) with primary open-angle glaucoma. Patients were divided into a thin CCT < 540 ?m (45 eyes) and a thick CCT ? 540 ?m (52 eyes) group, using ultrasonic pachymeter. Topographic measurements of the ONH parameters and RNFL thickness was performed using optical coherence tomography (OCT). The outcomes were compared with the thin and thick CCT and correlated with the thin CCT of the subjects. Results. There were significantly lower mean intraocular pressure (p < 0.0001) and CCT (p < 0.0001) in patients with thin CCT compared to patients with thick CCT. Statistically significant differences of ONH parameters were found in thin cornea group compared to thick cornea group in: cup/disc area ratio (p < 0.03), vertical cup/disc ratio (p < 0.01) and rim volume (p < 0.01). Statistically significant differences of RNFL thickness were found in thin cornea group compared to thick cornea group in: average (p < 0.001), superior (p < 0.03), inferior (p < 0.03) and nasal (p < 0.01). Significant positive correlation was found between thin CCT and OCT parameters in: optic disc area (r = 0.429, p = 0.003), cup/disc area ratio (r = 0.287, p = 0.05), horizontal cup/disc ratio (r = 0.472, p < 0.001), vertical cup/disc ratio (r = 0.578, p < 0.001), average RNFL (r = 0.796, p < 0.001), superior RNFL (r = 0.665, p < 0.001), inferior RNFL (r = 0.650, p < 0.001), nasal RNFL (r = 0.611, p < 0.001) and temporal RNFL thickness (r = 0.601, p < 0.001). Conclusion. POAG patients with thin cornea will probably develop larger glaucoma changes than those with a thicker cornea. Ultrasonic pachymetry measurements of CCT and OCT analysis of ONH topography parameters and RNFL thickness provide significant information in early diagnosis and monitoring progression of POAG.

Conocimientos sobre glaucoma primario de ángulo abierto: diseño y validación de un cuestionario en pacientes hispanohablantes de Perú

ObjectiveTo design and validate a questionnaire on the knowledge of primary open-angle glaucoma (POAG) in Spanish-speaking patients. MethodsAn observational study was conducted on adults with diagnosis of POAG and who received outpatient medical care in a national reference health care institute of Peru. The questionnaire was based on a literature review and expert judgment. A pilot study was carried out on 60 patients. The items were classified and weighted according to the expert judgment. The final questionnaire was completed by 314 patients and its overall score was scaled by tertiles. ResultsA total of 72 items were found by primary searching. The initial questionnaire was made up of 20 items, which was tested in a pilot study. A total of 14 items were selected that were then classified into 3weighted domains: risk factors (10%), clinical aspects (36%), and treatment (54%). The questionnaire has a score range from 0 to 100 points (lowest to highest level). In patients, the mean score was 62.6±14.1. The overall score was classified into 3categories of knowledge level: low (0 to 55 points), medium (56 to 69 points), and high (70 to 100 points). ConclusionsThe questionnaire provides evidence of validity to assess knowledge of POAG in Peruvian Spanish-speaking patients.

Роль полиморфизма rs2075575 гена аквапорина 4 в развитии первичной открытоугольной глаукомы

Актуальность. Несмотря на всестороннее изучение патогенеза первичной открытоугольной глаукомы (ПОУГ), механизмы возникновения заболевания до конца не изучены. В настоящее время определена роль аквапоринов в регуляции внутриглазного давления. Были обнаружены мутации, усиливающие и снижающие функции аквапорина 4, описано влияние различных генетических вариантов аквапоринов на величину внутриглазного давления. Цель исследования. Исследовать частоту встречаемости вариантов полиморфизма rs2075575 (C/Т) гена аквапорина 4 у больных ПОУГ. Материалы и методы. В исследовании приняли участие 101 пациент с ПОУГ и 80 здоровых людей (контрольная группа). Возраст исследуемых колебался от 45 до 87 лет. Средний возраст составил 66 лет. Критерием включения в основную группу служил диагноз ПОУГ развитой, далеко зашедшей и терминальной стадий. Критериями включения в контрольную группу служили возраст старше 60 лет, отсутствие глаукомы и выраженной соматической патологии. ДНК выделяли из буккального эпителия. Полиморфизм гена аквапорина 4 rs2075575 определяли методом полимеразной цепной реакции. Результаты. Установлено, что распределение генотипов у пациентов с ПОУГ отличается от группы здоровых лиц. Обнаружено, что генотип СС среди больных глаукомой встречается в 1,8 раза чаще, чем в контрольной группе. Наоборот, генотип СТ выявляется в 1,5 раза чаще в контрольной группе. Отношение шансов (OR) для генотипа СС равно 2,48 (95% CI 1,30-4,74). У генотипа СТ выявляется протекторная роль, OR =0,52 (95% CI 0,28-0,97). Частота встречаемости генотипа ТТ в исследуемых группах не различается. Выводы. Полиморфный вариант rs2075575 (C/Т) гена аквапорина 4 вносит вклад в риск развития ПОУГ в исследованной выборке. Background. Despite a comprehensive study of the pathogenesis of the disease, the mechanisms of primary open-angle glaucoma are not completely clear. Currently, the role of aquaporins in the regulation of intraocular pressure has been determined. Mutations were discovered that enhance and decrease the functions of aquaporin 4. The effect of various genetic variants of aquaporins on the value of intraocular pressure is described. The aim of research. To investigate the variability of the polymorphism of aquaporin 4 rs2075575 (C / T) in patients with glaucoma. Materials and methods. 101 persons with primary open-angle glaucoma and 80 persons without glaucoma (the control group) were examined. The age of the subjects ranged from 45 to 87 years. The average age was 66 years. The criterion for inclusion in the main group was the diagnosis of primary open-angle glaucoma of a developed, distant and terminal stage. The criteria for inclusion in the control group were age over 60 years, the absence of glaucoma, the absence of pronounced somatic pathology. DNAs were extracted from buccal epithelium. The polymerase chain reaction (PCR) method was used to determine the polymorphism of the aquaporin gene 4 rs2075575. Results. There was a significant difference in the distribution of genotypes in the study and control groups. СС genotype among patients with glaucoma occurs 1.8 times more often than in the control group. CT genotype, on the contrary, is 1.5 times more often in the control group. The odds ratio (OR) for this genotype is 2.48 (95% CI 1.30 - 4.74). The CT genotype reveals a protective role, OR = 0.52 (95% CI 0.28 - 0.97). The genotype of TT in the studied groups is slightly different in frequency of occurrence. Conclusion. The frequencies of gene polymorphisms of aquaporin 4 rs2075575 (C/Т) in patients with primary open-angle glaucoma and healthy were diverse. The likelihood of developing primary open-angle glaucoma is increased in carriers of the СС genotype. Genotype CT play a protective role for primary open-angle glaucoma.

Multi-Omics Approach for Studying Tears in Treatment-Naïve Glaucoma Patients.

Primary open-angle glaucoma (POAG) represents the leading cause of irreversible blindness worldwide and is a multifactorial, chronic neurodegenerative disease characterized by retinal ganglion cell and visual field loss. There are many factors that are associated with the risk of developing POAG, with increased intraocular pressure being one of the most prevalent. Due to the asymptomatic nature of the disease, the diagnosis of POAG often occurs too late, which necessitates development of new effective screening strategies for early diagnosis of the disease. However, this task still remains unfulfilled. In order to provide further insights into the pathophysiology of POAG, we applied a targeted metabolomics strategy based on a high-throughput screening method for the determination of tear amino acids, free carnitine, acylcarnitines, succinylacetone, nucleosides, and lysophospholipids in naïve to therapy glaucomatous patients and normal controls. Also, we conducted proteomic analyses of the whole lacrimal fluid and purified extracellular vesicles obtained from POAG patients and healthy subjects. This multi-omics approach allowed us to conclude that POAG patients had lower levels of certain tear amino acids and lysophospholipids compared with controls. These targeted analyses also highlighted the low amount of acetylcarnitine (C2) in POAG patient which correlated well with proteomics data. Moreover, POAG tear proteins seemed to derive from extracellular vesicles, which carried a specific pro-inflammatory protein cargo.

Primary Open-Angle African American Glaucoma Genetics (POAAGG) Study: gender and risk of POAG in African Americans.

The purpose of this study was to investigate the association between gender and primary open-angle glaucoma (POAG) among African Americans and to assess demographic, systemic, and behavioral factors that may contribute to differences between genders. The Primary Open-Angle African American Glaucoma Genetics (POAAGG) study had a case-control design and included African Americans 35 years and older, recruited from the greater Philadelphia, Pennsylvania. Diagnosis of POAG was based on evidence of both glaucomatous optic nerve damage and characteristic visual field loss. Demographic and behavioral information, history of systemic diseases and anthropometric measurements were obtained at study enrollment. Gender differences in risk of POAG were examined using multivariate logistic regression. A total of 2,290 POAG cases and 2,538 controls were included in the study. The percentage of men among cases was higher than among controls (38.6% vs 30.3%, P<0.001). The subjects’ mean age at enrollment was significantly higher for cases compared to controls (70.2±11.3 vs. 61.6±11.8 years, P<0.003). Cases had lower rates of diabetes (40% vs. 46%, P<0.001), higher rates of systemic hypertension (80% vs. 72%, P<0.001), and lower body mass index (BMI) (29.7±6.7 vs. 31.9±7.4, P<0.001) than controls. In the final multivariable model, male gender was significantly associated with POAG risk (OR, 1.64; 95% CI, 1.44–1.87; P<0.001), after adjusting for age, systemic hypertension, diabetes, and BMI. Within the POAAGG study, men were at higher risk of having POAG than women. Pending genetic results from this study will be used to better understand the underlying genetic variations that may account for these differences.

Особенности содержания трансформирующих факторов роста – бета 1,2,3 (TGF-β1, TGF-β2, TGF-β3) во внутриглазной жидкости при первичной открытоугольной глаукоме

Purpose. To study transforming growth factors – beta 1,2,3 (TGF-β1, TGF-β2, TGF-β3) in intraocular aqueous humor (AH) of patients with the advanced stage of primary open angle glaucoma (POAG). Material and methods. The study included an examination of 56 patients with advanced stage of POAG which comprised the main group. The diagnosis of POAG was confirmed based on ophthalmological examination. The control group consisted of 30 patients with uncomplicated cataract. TGF-β isoforms concentrations were detected by flow fluorimetry using Bio-Plex Pro™ TGF-β 3-plex Assay and double-beam laser analyzer Bio-Plex 200, Bio-Rad, USA. Three isoforms of TGF-β (TGF-β1, TGF-β2, TGF-β3) were simultaneously detected in AH. Results. The study revealed a significant increase of TGF-β isoforms concentrations in AH of the advanced POAG compared to AH of the group with uncomplicated cataract: TGF-β1 (3.1 times higher), TGF-β2 (1.4 times) and TGF-β3 (6.9 times). The following direct significant correlations were found: between TGF-β1 and TGF-β2 (r=0.41, p<0.03), between TGF-β1 and TGF-β3 (r=0.83, p<0.004), and between TGF-β2 and TGF-β3 (r=0.35, p<0.04). Conclusion. We determined a simultaneous increase of concentrations of the studied representatives of super-family transforming growth factors, which have an anti-inflammatory activity, potential to stimulate proliferation, cellular growth, synthesis of proteins of extracellular matrix, etc. These results prove their importance in the POAG pathogenesis.

Glaucoma Patient Knowledge, Perceptions, and Predispositions for Telemedicine.

The purpose was to identify factors associated with older glaucoma patients' knowledge of, perceptions of, and predispositions for telemedicine use. Established patients age 60 years and above with a diagnosis of primary open-angle glaucoma, glaucoma suspect, or ocular hypertension followed by a glaucoma fellowship-trained ophthalmologist were enrolled in the study at an academic, urban, tertiary referral eye clinic. Enrolled patients were administered a Life Space Questionnaire (LSQ), scored 0 to 9, and Preferences for Telemedicine Questionnaire (PTQ), a Likert scale validated tool. χ testing analyzed PTQ responses by age, race, education, employment status, LSQ score, and distance traveled from home address to clinic. A Mann-Whitney U test was used to compare PTQ responses by visual field index and visual acuity for the better and worse eye. Of 110 patients enrolled, 71% of patients agreed or were neutral to receiving telediagnosis and 74% of patients agreed or were neutral to receiving teleintervention. Patients aged 60 to 69 years compared with those 70 and above had significantly greater knowledge about types of telemedicine: telediagnosis (53% vs. 31%, P=0.02), teleintervention (49% vs. 24%, P=0.006), teletriage (80% vs. 47%, P=0.0004), and telemonitoring (55% vs. 27%, P=0.003). Patients of European descent had significantly more knowledge about teletriage compared with those of non-European descent (72% vs. 53%, P=0.04). Patients with more education (>high school) compared with those with less education (≤high school) had more knowledge about telemedicine (39% vs. 16%, P=0.007) and all the uses of it: telediagnosis (61% vs. 45%, P<0.001), teleintervention (54% vs. 14%, P<0.001), teletriage (86% vs. 35%, P<0.001), and telemonitoring (59% vs. 18%, P=0.001). Patients with a LSQ score ≥6, meaning they traveled a greater distance from home in the previous 3 days, displayed significantly more knowledge about telediagnosis (49% vs. 25%, P=0.02), teleintervention (43% vs. 19%, P=0.01), and telemonitoring (47% vs. 25%, P=0.03) than those with an LSQ<6. Responses to the PTQ were not significantly different by distance traveled. Knowledge of telemedicine was variable but between one third and one half of patients had favorable attitudes toward using telemedicine for glaucoma care.

Intereye and intraeye asymmetry analysis of retinal microvascular and neural structure parameters for diagnosis of primary open-angle glaucoma.

To investigate the diagnostic values of intereye or intraeye asymmetry of retinal perfused vessel density and neural structure parameters for detection of glaucoma. In total, 152 healthy subjects and 72 bilateral primary open-angle glaucoma (POAG) patients were enrolled. Total POAG group contains all glaucoma patients. Early to moderate POAG group contains patients whose binocular mean defect values were larger than -12 dB. The retinal perfused vessel densities were acquired using optic coherence tomography angiography. The neural structure parameters include RNFL, GCC thickness and its derivative indices like focal loss volume percentage (FLV%) and global loss volume percentage (GLV%). Intereye asymmetry equaled to the absolute difference of parameters between paired eyes. Intraeye asymmetry was defined as absolute difference between the inferior and superior hemisphere values from one random selected eye. The areas under the receiver operating characteristic curves (AUROCs) were calculated to evaluate diagnostic ability. From pairwise comparison analysis of ROC curves, the intereye asymmetric parameters with the largest diagnostic accuracy were FLV and GLV% (AUROC = 0.944), which were significantly superior to the intereye asymmetry of perfused vessel density in peripapillary area and parafoveal area (P < 0.05). Particularly, the intereye asymmetry of FLV% (AUROC = 0.926) and GLV% (AUROC = 0.950) showed excellent diagnostic precision for detecting early to moderate glaucoma patients. However, the intraeye asymmetry of microvascular parameters and neural structure parameters showed fair diagnostic ability for identifying POAG patients. The intereye asymmetry of neural structure parameters, particularly the FLV% and GLV%, outperformed the microvascular parameters for identifying POAG patients.

Five-Year, Prospective, Randomized, Multi-Surgeon Trial of Two Trabecular Bypass Stents versus Prostaglandin for Newly Diagnosed Open-Angle Glaucoma

To evaluate 5-year safety and efficacy of 2 trabecular micro-bypass stents versus prostaglandin as initial stand-alone treatment for newly diagnosed, treatment-naive primary open-angle glaucoma (POAG). Prospective, randomized, controlled, multi-surgeon clinical trial. Enrolled eyes (n= 101) were phakic and had a confirmed POAG diagnosis, normal angle anatomy, mean diurnal intraocular pressure (IOP) 21 to 40 mmHg, and vertical cup-to-disc (C:D) ratio ≤0.9. Eyes were randomized (1:1) to receive either 2 stents (iStent trabecular micro-bypass; Glaukos Corporation, San Clemente, CA) or once-daily topical travoprost. The primary and secondary efficacy end points were the change from screening in mean diurnal IOP at months 12 and 24, respectively, without glaucoma surgery or add-on medication (any medication in stent eyes or a second medication in travoprost eyes). Two additional secondary end points were the proportion of eyes achieving treatment success at months 12 and 24, defined as IOP 6 to 18 mmHg without additional medication or glaucoma surgery. This report shows these efficacy measures through 60 months. Safety measures included best-corrected visual acuity, C:D ratio, visual field, pachymetry, complications, and adverse events. Of 101 enrolled eyes (54 stent eyes, 47 travoprost eyes), 90 eyes (49 stent eyes, 41 travoprost eyes) completed 5-year follow-up. Five-year mean diurnal IOP was 16.5±1.2 mmHg in stent eyes (35.3% reduced vs. 25.5±2.5 mmHg preoperatively; P < 0.0001) and 16.3±1.9 mmHg in travoprost eyes (35.1% reduced vs. 25.1±4.6 mmHg preoperatively; P < 0.0001). During follow-up, add-on medication was initiated in 12 stent eyes (22.2% of the initial 54-eyes) and 18 travoprost eyes (38.3% of the initial 47-eyes). By 5 years, 17% (6/35) of stent eyes and 44% (14/32) of travoprost eyes needed add-on medication to control IOP (P= 0.017). Treatment success was achieved in 77% (27/35) of stent eyes and 53% (17/32) of travoprost eyes (P= 0.04). Both groups exhibited excellent safety. This prospective randomized trial demonstrates 5-year effectiveness and safety of 2 trabecular bypass stents in patients with newly diagnosed, treatment-naive POAG, with comparably favorable outcomes as topical prostaglandin.

The time relationship of retinal light threshold fluctuations and retinal nerve fiber layer and ganglion cell complex thickness changes on high-risk primary open-angle glaucoma

Objective To investigate the time relationship of the change, and diagnostic accuracy and sensitivity between retinal light threshold fluctuations (LTF) and retinal nerve fiber layer (RNFL) and ganglion cell complex(GCC) thickness on high-risk primary open-angle glaucoma (POAG). Methods Totally 319 patients (319 eyes) with high-risk in POAG from the First Affiliated Hospital of Kunming Medical Universityand during December 2009 and December 2017, 50 healthy individuals (50 eyes) as control were collected in this longitudinal cohort study. Visual field and OCT were reviewed every 6 months on the high-risk group and every 12 months on the control group. High-risk groups inclusion criteria: vertical C/D≥0.6; early visual field defect (according to glaucoma visual field damage GSS2 quantitative grading standards, mean deviation and pattern standard deviation of central field exceeds the border as an early visual field defect); continuous repeatable results. The first field and OCT results in the absence of visual field defects and C/D≥0.6, which were conformed reliability indicators and removed learning effects as a baseline. When patients achieve POAG diagnosis criteria first time which was recorded as a turning point. And they were divided into early group meanwhile were ended of follow-up. After the last follow-up, the inspection data was segmented counted in yearly interval. The changes of LTF, thickness of RNFL and GCC during the follow-up period in the early POAG group and the control group were observed. The loss rate and change rate in each period were compared for the assessment of their trends with time. Followed by calculation of the area under receiver operating curves (AUC) to compare the predicted value of POAG and the sensitivity at 95% specificity in each period. Results After last follow-up, totally 67 patients 67 eyes (early POAG group, 37 males and 30 females) were entered the turning point. The mean follow-up of the early POAG group and the control group were 6.6 and 6.4 years. The average RNFL thickness was 79.05±8.09 μm, GCC thickness was 71.58±8.41 μm, LTF was −6.05±7.02 dB in early POAG group. The average RNFL thickness was 93.49±6.24 μm, GCC thickness was 79.72±6.32 μm, LTF was −0.31±0.58 dB in the control group. The differences of LTF and the thickness of RNFL and GCC were statistically significant (t=−5.97, −10.42, −5.60; P<0.001). The AUC of RNFL, GCC thickness and LTF increased with time in the early POAG group. The sensitivity was gradually increased at 95% specificity: 5th year before to at turning point, RNFL thickness AUC was 0.15, 0.65, 0.71, 0.77, 0.85, 0.92, and sensitivity was 20%, 56%, 61%, 65%, 70%, 76%, respectively; GCC thickness AUC was 0.12, 0.53, 0.69, 0.74, 0.82, 0.90, and sensitivity was 14%, 53%, 69%, 74%, 82%, 90%, respectively; the AUC of LTF was 0.10, 0.21, 0.33, 0.75, 0.86, 0.91, and sensitivity was 7%, 17%, 44%, 65%, 78%, 87%, respectively. Conclusions The earliest time of structural functional damage of POAG is at the 4th year before confirmed, simultaneous RNFL diagnosis accuracy and sensitivity are better than GCC and LTF. The earliest time of visual functional damage of POAG is at the 2th year before confirmed, simultaneous LTF diagnosis accuracy and sensitivity are better than RNFL and GCC. Key words: Glaucoma, open-angle/diagnosis; Retinal light threshold fluctuation; Retinal nerve fiber layer thickness; Retinal ganglion cell complex thickness; Time relationship

Potential Biomarkers for Primary Open-Angle Glaucoma Identified by Long Noncoding RNA Profiling in the Aqueous Humor

This study aimed to identify potential biomarkers for primary open-angle glaucoma (POAG) diagnosis. First, long noncoding RNA (lncRNA) and mRNA expression profiles in the aqueous humor (AH) from 10 POAG and 10 control patients were accessed by microarray analyses. Coding-noncoding gene coexpression networks were drawn to predict potential lncRNA functions. lncRNA T267384, ENST00000607393, and T342877 expression levels were further tested by real-time quantitative PCR in AH from 29 POAG and 30 cataract patients, in iris tissues from 16 POAG patients and 10 controls, and in plasma from 49 POAG patients and 55 healthy controls. Finally, ENST00000607393 function was characterized in an invitro model of cell calcification. A total of 3627 lncRNAs and 2228 mRNAs in the AH of POAG patients were significantly up-regulated, and 1520 lncRNAs and 820 mRNAs were significantly down-regulated. Seven lncRNAs showed positive correlation with glaucoma-associated gene, bone morphogenetic protein 2. Moreover, real-time quantitative RT-PCR confirmed that T267384, ENST00000607393, and T342877 expression levels were significantly higher in the AH from a different cohort of POAG patients. ENST00000607393 was also significantly higher in the iris and plasma of POAG patients. Last, ENST00000607393 knockdown alleviated calcification of primary human trabecular meshwork cells invitro. Therefore, lncRNAs T267384, ENST00000607393, and T342877 may be potential biomarkers for POAG diagnosis. ENST00000607393 might be a new therapeutic target for trabecular meshwork calcification.

The clinical feature of myocilin Y437H mutation in a Chinese family with primary open-angle glaucoma

PurposeTo characterise the genotype(s), phenotype(s) and age-related penetrance of glaucoma in a Chinese family with primary open-angle glaucoma (POAG).MethodsRecruited from a Chinese family spanning four generations, 7 individuals with POAG,...

Comparative study of efficacy of latanoprost (0.005%) and dorzolamide (2%), in primary open-angle glaucoma patients, as monotherapy

Background: Glaucoma is the second most common cause of blindness worldwide and also in India and its prevalence is increasing. Raised intraocular pressure (IOP) is most important and directly related to development of primary open-angle glaucoma (POAG). Hence, the present study carried out to compare the efficacy between latanoprost and dorzolamide for reducing IOP in POAG as monotherapy. Aims and Objectives: The objectives are as follows: (i) To compare the efficacy between topical latanoprost (0.005%) and topical dorzolamide (2%) in POAG as monotherapy, and (ii) to evaluate the adverse effects of latanoprost and dorzolamide. Materials and Methods: The present prospective, open-labeled study was conducted in 80 patients males and females which were selected randomly with POAG diagnosis and divided into two groups. One group received latanoprost (0.005%) topical eye drops once a day and other group received dorzolamide (2%) eye drops 3 times a day. All participants were followed up for three visits at 2 weeks, 4 weeks, and 8 weeks. Before starting on treatment baseline, IOP was recorded by Perkins Hand Held Tonometer. Again during each follow-up visit, IOP was recorded to know the response of drugs. The informed consent was taken from all patients and ethical clearance was taken from institution. Results: The mean IOP reduction for latanoprost group was 9.5 ± 3.56 and dorzolamide group was 7.89 ± 3.56. Both drugs were effective in reducing IOP. The difference in IOP reduction between latanoprost and dorzolamide was statistically significant (P = 0.02). Both drugs were well tolerated during study period, maximum side effects seen in latanoprost group (n = 9) compared to dorzolamide group (n = 7). Conclusion: The present study concludes that both latanoprost (0.005%) and dorzolamide (2%) topical eye drops effectively reduce IOP in POAG. The latanoprost is more efficacious compared to dorzolamide in reducing IOP.

Diagnostic utility of central damage determination in glaucoma by magnetic resonance imaging: An observational study.

The aim of the present study was to investigate the utility of diffusion tensor imaging (DTI) parameters of the central visual pathway and the size of the lateral geniculate nucleus (LGN) in the diagnosis of primary open-angle glaucoma (POAG). To test this, 24 POAG patients and 24 age- and gender-matched controls underwent 3.0 Tesla magnetic resonance imaging examinations, including DTI and LGN structural imaging. Receiver operating characteristic (ROC) curves were generated and Spearman's correlation coefficients were also determined. The results indicated that regarding the discrimination of POAG patients from healthy controls, the fractional anisotropy (FA) values of the optic tract, at a cutoff of ≤0.412, with an area under the ROC curve of 0.931, exhibited the highest sensitivity (79.2%) and specificity (89.6%). The FA values of the optic tract and the optic radiation were significantly correlated with LGN size, while the mean diffusivity values were not. In conclusion, the FA value of the optic tract may be a sensitive and reliable biomarker for glaucoma evaluation.