Glaucoma Control Research Articles

Comparison of macular structural and vascular changes in neuromyelitis optica spectrum disorder and primary open angle glaucoma: a cross-sectional study

AimsTo compare macular structure and vasculature between neuromyelitis optica spectrum disorder (NMOSD) and primary open angle glaucoma (POAG) using optical coherence tomography angiography.MethodsNMOSD patients (n=124) with/without a history of optic...

Asymmetry analysis of macular optical coherence tomography angiography in patients with glaucoma and healthy subjects

Background/aimsQuantitative analysis of optical coherence tomography angiography (OCT-A) images requires a reproducible approach that accounts for sectoral loss. The objective of this study was to determine whether an index that...

Endogenous ocular lipids as potential modulators of intraocular pressure.

Elevated intraocular pressure (IOP) is a risk factor in glaucoma, a group of irreversible blinding diseases. Endogenous lipids may be involved in regulation of IOP homeostasis. We present comparative fold analysis of phospholipids and sphingolipids of aqueous humour and trabecular meshwork from human control vs primary open‐angle glaucoma and mouse control (normotensive) vs ocular hypertensive state. The fold analysis in control vs disease state was based on ratiometric mass spectrometric data for above classes of lipids. We standardized in vitro assays for rapid characterization of lipids undergoing significant diminishment in disease state. Evaluation of lipids using in vitro assays helped select a finite number of lipids that may potentially expand cellular interstitial space embedded in an artificial matrix or increase fluid flow across a layer of cells. These assays reduced a number of lipids for initial evaluation using a mouse model, DBA/2J with spontaneous IOP elevation. These lipids were then used in other mouse models for confirmation of IOP lowering potential of a few lipids that were found promising in previous assessments. Our results provide selected lipid molecules that can be pursued for further evaluation and studies that may provide insight into their function.

Vitreous albumin redox state in open-angle glaucoma patients and controls: a pilot study

PurposeNumerous studies suggest that reactive oxygen species play a crucial role in the development of glaucoma. Since glaucoma patients exhibit posterior vitreous detachment earlier than controls, it has been suggested that reactive oxygen species—increased in glaucoma—also affect the vitreous. In the present study we evaluated the influence of open-angle glaucoma oxidative stress on the redox state of vitreous albumin.MethodsAlbumin redox states of the vitreous and plasma were evaluated in 22 subjects—11 open-angle glaucoma patients and 11 controls—matched for age, gender, and vitreous state. According to the redox state of cysteine-34, albumin can be separated into: human mercaptalbumin (the thiol form), human nonmercaptalbumin1 (a reversible modification due to mild oxidation), and human nonmercaptalbumin2 (an irreversible modification due to severe oxidation).ResultsAlbumin of both, the open-angle glaucoma group and the control group, was more oxidized in the vitreous compared to plasma. Furthermore, significantly higher human nonmercaptalbumin1 fractions were found in the vitreous of open-angle glaucoma patients compared to controls. No significant differences were found in the plasma albumin fractions between the groups.ConclusionOur results support the hypothesis that oxidative stress plays a crucial role in open-angle glaucoma and that reactive oxygen species in glaucomatous eyes may also affect the vitreous.

A comparison of the corneal biomechanics in pseudoexfoliation syndrome, pseudoexfoliation glaucoma, and healthy controls using Corvis® Scheimpflug Technology.

Purpose:To compare the corneal biomechanical parameters among pseudoexfoliation syndrome (PXF), pseudoexfoliation glaucoma (PXG), and healthy controls using Corvis Scheimpflug Technology (ST).Methods:A prospective, cross-sectional study of 141 treatment-naïve eyes that underwent Corvis ST was conducted. These included 42 eyes with PXF, 17 eyes of PXF with ocular hypertension (PXF + OHT) defined as intraocular pressure (IOP) >21 mmHg without disc/field changes, 37 eyes with PXG, and 45 healthy controls. Corneal biomechanical parameters, which included corneal velocities, length of corneal applanated surface, deformation amplitude (DA), peak distance, and radius of curvature, were compared among the groups using analysis of variance models.Results:The four groups were demographically similar. The mean IOP was lower in the controls (15.6 ± 3 mmHg) and PXF group (16.0 ± 3 mmHg) compared to the other two groups (>24 mmHg). Corneal pachymetry was similar across the four groups. Mean DA was significantly lower (P < 0.0001) in the PXG group (0.91 ± 0.18 mm) and the PXF + OHT group (0.94 ± 0.13 mm) when compared to the PXF (1.10 ± 0.11 mm) and control groups (1.12 ± 0.14 mm). Corneal velocities were also found to be statistically significantly lower in PXG and PXF + OHT compared to the PXF and control groups. However, after adjusting for age and IOP, there was no difference in any of the biomechanical parameters among the four groups.Conclusion:Corneal biomechanical parameters measured on Corvis ST are not different between healthy controls and eyes with PXF and PXG. Since PXG is a high-pressure glaucoma, corneal biomechanics may not play an important role in its diagnosis and pathogenesis.

The Impact of Glaucoma on the Mental Health of Primary Open-Angle Glaucoma Patients Attending a Teaching Hospital in South East Nigeria.

Objective:To evaluate the effect of glaucoma on the mental health of primary open-angle glaucoma patients using Hospital Anxiety and Depression Scale (HADS)Materials and Methods:This was a hospital-based comparative study in which 180 glaucoma patients and controls 18 years and above who met the inclusion criteria were selected consecutively in the Eye Clinic of Federal Medical Centre, Owerri, Imo State, in 2017. Data were collected using a questionnaire and the HADS protocol. All the participants underwent comprehensive ocular examination, and glaucoma was graded using visual field perimetric indices and mean deviation.Results:The mean age for cases was 58.14 ± 13.88 years, whereas that of the control group was 57.19 ± 13.76 years. The majority of glaucoma respondents had the moderate form of the disease followed by the severe form. The glaucoma patients showed evidence of poor mental health with 59 (32.8%) of them anxious and 39 (21.7%) depressed compared to controls (P < 0.001). The mean scores for anxiety and depression were 6.02 ± 4.8 and 5.20 ± 4.5, respectively, for glaucoma patients, whereas those for the control group were 0.63 ± 1.8 and 0.64 ± 2.1, respectively (P < 0.001). There was no uniform correlation between the mental health of patients and the variables under study.Conclusion:Primary open-angle glaucoma affects the mental health of patients. This effect is worsened by the severity of the disease and influenced by the occupation and educational level of the patients. Multidisciplinary management of primary open-angle glaucoma patients is recommended.

Association of lamina cribrosa morphometry with retinal nerve fiber layer loss and visual field defects in primary open angle glaucoma.

Objectives:To calculate the anterior lamina cribrosa depth (ALCD) and lamina cribrosa thickness (LCT) in primary open angle glaucoma (POAG) patients and controls and to correlate lamina cribrosa (LC) parameters to retinal nerve fiber layer thickness (RNFLT) and visual field (VF) defects.Methods:The study was conducted from November 2018 to March 2019. A total of 60 correspondents (30 cases and 30 controls) were assessed for general ophthalmological investigations including intraocular pressure (IOP), axial length AXL, ophthalmoscopy, visual field (VF) testing and spectral domain ocular computed tomography (SDOCT).Results:The mean age of subjects was 62 years (Cases 67.30±1.2, controls 57.32±1.1) with more male participants. Intraocular pressure [IOP (19.85 ±1.4)], AXL (22.85 ± 1.6), VF defects (8.30 ± 4.5), RNFLT (72.58 ± 13.2) and LCT (162.51 ± 64.62) were statistically significant in POAG patients as compared to the controls.Conclusion:A thinner LC in POAG correlated significantly with the RNFLT and VF defects. LC anatomical parameters can be estimated with precision using SDOCT with enhanced depth imaging (EDI).

Altered Intrinsic Functional Connectivity of the Primary Visual Cortex in Patients with Neovascular Glaucoma: A Resting-State Functional Magnetic Resonance Imaging Study.

PurposeThe purpose was to investigate the differences in spontaneous functional connectivity (FC) of the primary visual cortex (V1) between patients with neovascular glaucoma (NVG) and healthy controls (HCs) using resting-state functional magnetic resonance imaging data.MethodsA total of 18 patients with NVG (nine males and nine females) and 18 HCs with similar age and sex background were enrolled in the study and inspected using resting-state functional magnetic resonance imaging. The differences in FC of the V1 between the two groups were compared using the independent samples t-test. We used the receiver operating characteristic (ROC) curve to compare the average FC values of NVG subjects with those of HCs.ResultsFC in the left V1 and right fusiform gyrus, bilateral cuneus, and left precuneus was significantly decreased in the NVG group compared with that reported in the HC group. Meanwhile, patients with NVG presented increased FC between the right V1 and bilateral middle frontal gyrus. However, they also exhibited declining FC between the right V1 and left precuneus, and bilateral cuneus. The ROC curve analysis of each brain region indicated that the accuracy of the area under the ROC curves regarding NVG was excellent.ConclusionNVG involves aberrant FC in the V1 in different brain areas, including the visual-related and cognitive-related regions. These findings may assist in unveiling the underlying neural mechanisms of impaired visual function in NVG.

Aqueous humor metabolite profile of pseudoexfoliation glaucoma is distinctive.

Pseudoexfoliation (PEX) is a known cause of secondary open angle glaucoma. PEX glaucoma is associated with structural and metabolic changes in the eye. Despite similarities, PEX and primary open angle glaucoma (POAG) may have differences in the composition of metabolites. We analyzed the metabolites of the aqueous humor (AH) of PEX subjects sequentially first using nuclear magnetic resonance (1H NMR: HSQC and TOCSY), and subsequently with liquid chromatography tandem mass spectrometry (LC-MS/MS) implementing isotopic ratio outlier analysis (IROA) quantification. The findings were compared with previous results for POAG and control subjects analyzed using identical sequential steps. We found significant differences in metabolites between the three conditions. Principle component analysis (PCA) and partial least squares discriminant analysis (PLS-DA) indicated clear grouping based on the metabolomes of the three conditions. We used machine learning algorithms and a percentage set of the data to train, and utilized a different or larger dataset to test whether a trained model can correctly classify the test dataset as PEX, POAG or control. Three different algorithms: linear support vector machines (SVM), deep learning, and a neural network were used for prediction. They all accurately classified the test datasets based on the AH metabolome of the sample. We next compared the AH metabolome with known AH and TM proteomes and genomes in order to understand metabolic pathways that may contribute to alterations in the AH metabolome in PEX. We found potential protein/gene pathways associated with observed significant metabolite changes in PEX.

The prevalence of diabetes among male glaucoma patients

Introduction: The purpose of this study was to examine the relationship between diabetes and glaucoma.Methods: Consecutive 143 subjects with primary angle-closure glaucoma and 127 subjects with primary open-angle glaucoma (control) were studied retrospectively at an urban Veterans Administration Hospital. In addition to ocular examination findings, body mass index (BMI) and diabetes mellitus (DM) status were recorded.Results: All subjects in this study were male. The mean age was 72.3 years old in primary open angle versus 71.1 in primary angle-closure subjects. Half of the subjects with angle closure and 70% of open-angle subjects were self-identified as African–American. BMI was not significantly different between the two groups (28.2 in open angle vs. 28.7 in angle closure; P = 0.45). The percentage of DM was higher in subjects with primary angle closure than in those with primary open-angle glaucoma (43% vs. 29%, P = 0.001; Chi-square test). The odds of having DM were nearly two times higher in angle-closure subjects than open-angle subjects (Logistic regression, P = 0.01, 95% confidence interval: 1.17–3.30).Conclusion: In this retrospective study, diabetes was found to be associated with higher risk for primary angle-closure glaucoma.

Динамика распространенности глаукомы в Киргизской Республике

This article discusses the dynamics of glaucoma prevalence in the Kyrgyz Republic. At present glaucoma is one of the pressing problems of modern health care, as it occupies one of the leading places among the causes of irreversible loss of vision. According to WHO glaucoma accounts for up to 5% of all eye pathology. By 2020, the number of patients will increase to 5.9 million and 5.3 million will lose sight due to primary glaucoma. The proportion of primary glaucoma among the causes of primary disability has been stable at a fairly high level from 20 to 28% over the years. The problem of glaucoma control requires improvement of the system of organization of early detection and dispensary observation of patients, which will contribute to control of the level of morbidity and quality of medical care. The article used data from the Republican Medical and Information Center of the Ministry of Health of the Kyrgyz Republic from 2014 to 2018. On the basis of a comprehensive analysis, the authors identified trends in the incidence of diseases of the eye and its appendages, glaucoma among adults, adolescents and children of the Kyrgyz Republic. The incidence of diseases of the eye and its appendages, glaucoma among adults, teenagers and children in dynamics from 2014 to 2018 has been studied. The share of glaucoma in the total number of diseases of the eye and its appendages among adults, teenagers and children is considered. Analysis of the dynamics of disease prevalence of the eye, its appendages, glaucoma, both among adults and teenagers, and among children under 14 years of age showed an increase in the indicator in 2015, 2017 and 2018. The proportion of glaucoma from the total morbidity of the eye and its appendages among adults and adolescents in the years under study averaged 6.4%, among children under 14 — 0.2%. It is necessary to strengthen measures for early detection, dispensarization of glaucoma patients, as well as to carry out information work among the population.

A comparative study of fasting serum lipid profile between glaucoma patients and controls

Glaucoma constitutes 10% of blindness worldwide which is the third most common cause of blindness with majority of people being undiagnosed in developing countries. Aims: To assess and compare serum lipid profile between normotensive, non diabetic POAG patients and normotensive, non diabetic non glaucoma controls. Results: 1: Mean total cholesterol levels were (219±60.010) mg/dl and (191.26±43.167) mg/dl in glaucoma patients and controls respectively and the difference was statistically significant (p Conclusion: Higher total cholesterol levels and LDL-C levels were found in glaucoma patients as compared to controls. While there was no significant difference of serum triglycerides, HDL-C, VLDL-C levels between both the groups. Keywords: Age, Glaucoma, Lipid profile, Open angle, Total cholesterol.

Th17 cells in glaucoma patients promote Ig production in IL-17A and IL-21-dependent manner.

Elevated expression of autoantibodies is a hallmark of immune dysregulation in glaucoma and may cause retinal ganglion cell apoptosis and immune-mediated nerve damage, thus contributing to the development of blindness. The cause of autoantibody upregulation remains unclear. Th17 cells are shown to promote autoimmunity and Ig production. Here, we demonstrate that the serum levels of interleukin (IL)-17A and IL-21 are comparable between glaucoma patients and non-glaucoma controls. However, the levels of Th17-promoting cytokines, such as tumour necrosis factor (TNF) IL-6, are higher in glaucoma patients than in controls. Subsequently, we demonstrate that glaucoma patients present upregulated levels of Th17 cells that are quiescent directly ex vivo. Interestingly, compared to the Th17 cells from non-glaucoma subjects, the Th17 cells from glaucoma patients present similar IL-17A production capacity but significantly higher IL-21 production capacity. Given that IL-21 is also described as a specific cytokine of follicular helper T cells, the Ig production by B cells following co-incubation with circulating Th17 cells is investigated. Th17 cells from glaucoma patients present significantly enhanced potential to promote Ig production than the Th17 cells from controls. Both glaucoma patient Th17 cells and control Th17 cells require IL-17A and IL-21 for Ig production. Overall, results from this study suggest that Th17 cells from glaucoma patients present elevated capacity to stimulate Ig production.

Comparison of vessel density in eyes of children with juvenile open angle glaucoma and healthy age-matched controls: an optical coherence tomography angiography study

Comparison of vessel density in eyes of children with juvenile open angle glaucoma and healthy age-matched controls: an optical coherence tomography angiography study

Association of TNF-α gene alterations (c.-238G>A, c.-308G>A, c.-857C>T, c.-863C>A) with primary glaucoma in north Indian cohort

BackgroundTumor Necrosis Factor-alpha (TNF-α) a pleuripotent pro-inflammatory cytokine, is involved in retinal ganglion cells apoptosis in glaucoma. Thus present study aimed to analyze the association of TNF-α promoter region alterations (c.-238G>A (rs361525), c.-308G>A (rs1800629), c.-857C>T (rs1799724) and c.-863C>A (rs1800630)) with glaucoma in north Indian cohort. MethodsPresent hospital based case control study involved 286 glaucoma patients (Primary Open Angle Glaucoma [POAG], Primary Angle Closure Glaucoma [PACG], Primary Congenital Glaucoma [PCG]) and 300 controls. TNF-α gene alteration (c.-238G>A (also referred as c.-418G>A; NM_000594.3)), c.-308G>A (c.-488G>A; NM_000594.3), c.-857C>T (c.-1037C>T; NM_000594.3) and c.-863C>A (c.-1043C>A; NM_000594.3) harboring regions were PCR amplified and sequenced by Sanger sequencing. Allele frequency and genotype distribution in glaucoma cases and controls were compared using chi-square test and genetic association tested using different genetic models. ResultsStatistically significant genotype and allelic association was observed between glaucoma cases and controls for c.-308G>A and c.-863C>A alterations (p = 0.001, p = 0.001; p = 0.001, p = 0.001 respectively). AA genotype of c.-308G>A conferred ~7 fold increased risk towards glaucoma (OR = 6.82, 95% CI = 2.82–16.53, p = 0.001). c.-863C>A alteration under dominant, recessive and co-dominant genetic models conferred ~2 fold increased risk for glaucoma. However, no association for c.-238G>A and c.-857C>T variants with glaucoma was observed. Further, three haplotypes (GGCA, GACC and GACA) (OR = 0.48, 95% CI = 0.35–0.67, p = 0.001; OR = 0.58, 95% CI = 0.36–0.91, p = 0.019 and OR = 0.16, 95% CI = 0.05–0.51, p = 0.002, respectively) conferred protective role towards glaucoma. ConclusionsPresent study is the first to indicate significant association of c.-308G>A and c.-863C>A alterations with glaucoma in cases from north Indian cohort. Also it is the first study from India to analyze the association and interaction of four promoter region alterations (c.-238G>A, c.-308G>A, c.-857C>T and c.-863C>A) in TNF-α resulting in three protective haplotypes.

Identification of pathogenic genes and transcription factors in glaucoma.

Glaucoma is a group of eye diseases characterized by alterations in the contour of the optic nerve head, with corresponding visual field defects and progressive loss of retinal ganglion cells. The present study aimed to identify the key genes and upstream regulators in glaucoma. To screen the pathogenic genes involved in glaucoma, an integrated analysis was performed by using the microarray datasets in glaucoma derived from the Gene Expression Omnibus (GEO) database. The functional annotation and potential pathways of differentially expressed genes (DEGs) were additionally examined by Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analyses. A glaucoma‑specific transcriptional regulatory network was constructed to identify crucial transcriptional factors that target the DEGs in glaucoma. From two GEO datasets, 1,935 DEGs (951 upregulated and 984 downregulated genes) between glaucoma and normal controls were identified. GO and KEGG analyses identified that 'eye development' [false discovery rate (FDR)=0.00415533] and 'visual perception' (FDR=0.00713283) were significantly enriched pathways for DEGs. The expression of lipocalin 2 (LCN2), monoamine oxidase A (MAOA), hemoglobin subunit β (HBB), paired box 6 (PAX6), fibronectin (FN1) and cAMP responsive element binding protein 1 (CREB1) were demonstrated to be involved in the pathogenesis of glaucoma. In conclusion, LCN2, MAOA, HBB, PAX6, FN1 and CREB1 may serve roles in glaucoma, regulated by PAX4, solute carrier family 22 member 1, hepatocyte nuclear factor 4 α and ELK1, ETS transcription factor. These data may contribute to the development of novel potential biomarkers, reveal the underlying pathogenesis and additionally identify novel therapeutic targets for glaucoma.

Incision-Free Minimally Invasive Conjunctival Surgery (MICS) for Late-Onset Bleb Leaks After Trabeculectomy (An American Ophthalmological Society Thesis)

This study describes an incision-free minimally invasive conjunctival surgical (MICS) technique to repair late-onset leaking blebs after trabeculectomy. A surgical technique to repair leaking blebs without incision or excision of conjunctiva is described. This is followed by retrospective review of all patients treated at the Glaucoma Unit at St. Michael's Hospital for bleb leaks repaired with MICS from 2012 to 2017. With Research Ethics Board approval, clinical data obtained from the charts included demographic information, vision, intraocular pressure (IOP) data before and after surgery, need for additional medication, and complications. Resolution of the bleb leak without the need for additional therapy or intervention for glaucoma control was considered a success. The MICS approach was applied to 14 eyes of 13 consecutive patients with a leaking bleb. Mean age of presentation was 70.2 ± 14.8 years, and all patients had a history of mitomycin use at the time of glaucoma surgery. The onset of bleb leak following trabeculectomy ranged from 7months to 16.3 years. Mean pre-operative IOP was 4.5 ± 2.8mm Hg; IOP measured 12.3 ±3.0mm Hg immediately after the procedure. Complete resolution of the bleb leak was observed following surgery in all cases. The follow-up period ranged from 2weeks to 61months (10.2 ± 18.1). Recurrent bleb leak was reported in 1 patient 2 years following initial surgery. In all cases, the initially repaired filtering blebs remained functional at last follow-up, and no additional medications were required. The MICS procedure is an effective option for treating late-onset leaking blebs without cutting or excising conjunctival tissue. The minimal requirements of this method make it additionally accessible to low-resource settings. NOTE: Publication of this article is sponsored bythe American Ophthalmological Society.

Measurable Aspects of the Retinal Neurovascular Unit in Diabetes, Glaucoma, and Controls

To study the structural and angiographic optical coherence tomography (OCT) data of the macula from controls, patients with diabetes, and patients with glaucoma to evaluate neurovascular and structural relationships. This was a retrospective study of 89 eyes from 49 patients in a community-based retinal referral practice with diabetes, glaucoma, and normal controls. The patients were evaluated with OCT to include retinal nerve fiber layer (RNFL) thickness measurement and ganglion cell layer (GCL) volume determination. The vascular density of the radial peripapillary capillary network and the vascular plexuses in the macula were evaluated with OCT angiography. The main outcome measures were the data obtained per disease state and the interrelationships the data displayed. The mean GCL volumes were significantly lower than the control group in both the diabetic (P= .016) and glaucoma (P < .001) groups. The difference between the diabetic and glaucoma groups was not significant (P= .052). The mean global vascular density was greater in the control group than the diabetic group (P= .002) and the glaucoma group (P < .001). The mean RNFL thicknesses were lowest in the glaucoma group. Both the diabetic and glaucoma groups had significantly lower radial peripapillary network and deep vascular plexus density values compared to controls. Although there are important differences in disease pathogenesis between diabetes and glaucoma, they share certain similarities in the structural and angiographic abnormalities eventually produced. This suggests that, in addition to canonical pathways of disease, a component of both could represent neurodegenerative disease, offering the possibility for the development of new treatments. NOTE: Publication of this article is sponsored bythe American Ophthalmological Society.

Dark Adaptation Survey as a Predictive Tool for Primary Open-Angle Glaucoma

To study the extent to which patients with primary open-angle glaucoma (POAG) have subjective difficulties with dark (DA) adaptation and vision under low-luminance conditions and to correlate the reported difficulties with severity of disease, specifically visual field loss. Prospective, comparative case series. Two hundred twenty patients with and without POAG who sought treatment at an outpatient subspecialty glaucoma clinic between October 2016 and September2018. A questionnaire designed to assess difficulties with DA and vision under low luminance (the DA survey) was developed and given to patients during routine clinical evaluation in a hospital-based eye clinic. Retrospective data related to ocular health and glaucoma severity were abstracted from the medical record. A multiple regression analysis was performed to create a predictive model for POAG. Severity of glaucoma, specifically visual field loss, and classification of participants as glaucoma patients or control participants. Eighty-five patients with POAG and 127 control participants completed the questionnaire. Exploratory factor analysis of the DA survey using a principal components analysis showed that the items split into 2 dimensions: tasks that involved difficulty with vision under low luminance and those that required DA. Cronbach's α showed a high degree of internal consistency reliability (α= 0.88). Increasing DA survey score correlated with binocular visual field loss among patients with mild, moderate, and advanced POAG (P < 0.001). A model used to differentiate patients with POAG from control participants that included average and intereye difference in cup-to-disc ratio, family history of glaucoma, and DA survey score showed an accuracy, sensitivity, and specificity of 96.7%, 92.9%, and 99.2%, respectively. This pilot study revealed that problems with DA and vision under low luminance are commonly encountered by patients with POAG. These areas of visual disability are not assessed routinely in glaucoma care. A questionnaire assessing vision under low luminance and light-dark transitions may serve as a proxy for functional impairment in glaucoma. When paired with risk factors such as structural features of the optic nerve and family history, this survey instrument may be suitable to screen for patients with POAG.

The clinical features in patients with newly diagnosed pseudoexfoliative glaucoma in Serbia.

To evaluate the clinical characteristics of newly diagnosed pseudoexfoliative glaucoma and compare them with those pertaining to newly diagnosed primary open-angle glaucoma as well as pseudoexfoliation syndrome. This case-control study involved 306 participants, including patients with newly diagnosed pseudoexfoliative glaucoma, age- and sex-matched normal controls, patients with newly diagnosed primary open-angle glaucoma, and subjects with pseudoexfoliation syndrome. The study was conducted at the Glaucoma Department of Clinic for Eye Diseases, Clinical Center of Serbia, as the referral center for glaucoma in Serbia. The mean age in the pseudoexfoliative glaucoma, primary open-angle glaucoma, pseudoexfoliation syndrome, and normal control groups was 73.61 ± 8.46, 65.50 ± 8.97, 74.81 ± 6.80, and 73.58 ± 9.34 years, respectively (pseudoexfoliative glaucoma vs primary open-angle glaucoma, p < 0.001). Unilateral pseudoexfoliative glaucoma was diagnosed in 35 patients (42.2%). The intraocular pressure was higher in the eyes affected by pseudoexfoliative glaucoma (32.0 ± 9.5 mmHg) than that in the primary open-angle glaucoma eyes (28.8 ± 5.9 mmHg) (p < 0.001). In pseudoexfoliative glaucoma and primary open-angle glaucoma eyes, glaucoma severity was determined via the vertical cup-to-disk ratio (C/D) 0.65 (0.45-1.0) versus 0.60 (0.45-1.0), p = 0.048 and visual field mean deviation -5.68 (-1.58 to -30.9) versus -4.70 (-1.39 to -31.0), p = 0.045. Alzheimer's was the only systemic disease associated with pseudoexfoliative glaucoma in the study sample, with an odds ratio of 0.021 (95% confidence interval = 0.00-21.52, p = 0.022). At the time of diagnosis, pseudoexfoliative glaucoma exhibits different clinical features compared with primary open-angle glaucoma. Higher intraocular pressure, narrow or occludable angle, increased trabecular pigmentation, phacodonesis, and poorer pupillary dilatation emerged as the factors associated with pseudoexfoliative glaucoma.