POAG Patients Research Articles

The role of conjunctival lymphangiogenesis in filtering blebs formation after non-penetrating deep sclerectomy

Purpose: to study the concentration of vascular endothelial growth factor (VEGF A) in the tear fluid (TF) of patients with primary open-angle glaucoma after non-penetrating deep sclerectomy (NPDS) at different stages of the perioperative period and to perform immunohistochemical identification of the lymphatic structures of filtering blebs in groups differing in the hypotensive effect of the surgery.Material and methods. 12 months after surgery, POAG patients were divided into 2 groups. Group 1 was composed of patients who experienced a hypotensive effect after NPDS (n = 23; mean age 63.7 ± 4.4 years), while group 2 had no such effect of NPDS (n = 21, mean age 64.3 ± 3.9 years). The concentration of VEGF A (121 and 165) in TF was determined by ELISA method (VEGF-ELISA-Best, Vector Best, Russia). Immunohistochemical examination of conjunctival and subconjunctival tissue samples was performed 12 to 18 months after NPDS in 12 POAG patients and 8 patients aged 62.36 ± 6,31 with no glaucoma, which served as a control group.Results. Significant differences in the concentration of VEGF A (121 and 165) in TF were found in two groups 2 weeks and 2 months after the surgery. Excessive scarring of filtering blebs was accompanied by an initially low level of VEGF A, its moderate increase 2 weeks after surgery and significant suppression 2 months after surgery, which was significantly different from group 1 (a twofold VEGF A increase has been established toward the second month after surgery). From 5 to 7 vessels with lymphatic character were found in tissue samples of group 1. Podoplanin was found in individual cells and sphere-like formations, which may represent reduced lymphatic vessels.Conclusion. The study showed an important role of VEGF A in conjunctival lymphangiogenesis. Suppression of conjunctival lymphangiogenesis and subsequent “hypotensive failure” of glaucoma surgery in some patients who underwent anti-inflammatory and antifibrosis therapy requires optimization, the development of new treatment methods aimed at activating prolymphangiogenic factors.

THE RELATIONSHIP BETWEEN PLATELET COUNT, PDW, PCT, AND MPV WITH VISUAL FIELD DEFECT IN PRIMARY OPEN ANGLE GLAUCOMA

Abstract. Glaucoma is a multifactorial disease and the second leading cause of irreversible blindness worldwide, and incidence of open-angle glaucoma more frequent, including in Indonesia. The etiology is still unclear, but the risk factors are the immune system and increased systemic microvascular abnormalities affected by platelets. Objective. The purpose of this study was to determine the relationship between platelet parameters and visual field defect in POAG. Methods. This research is an analytic study with a case control design. Respondents are 30 POAG patients and 30 normal subjects as a control in Universitas Sumatera Utara Hospital and Satellite Hospital from August to December 2021. Venous blood samples were taken as much as 3 cc to assess platelet parameters, then analyzed in the clinical laboratory. Each group was examined with Humphrey's Perimetry which was further classified based on Hodapp Anderson Parrish criteria. Results. Most subjects in the POAG group are male, 53.3%. In POAG group the mean values of platelet count 267.28 103/μL, PDW 11.41 fL, PCT 0.25%, and MPV 9.49 fL. Conclusion. There was an increase in PDW values in advanced POAG patients, but no significant differences were found in visual field defect between the two groups.

Study to Identify and Evaluate Predictor Factors for Primary Open-Angle Glaucoma in Tertiary Prophylactic Actions.

The aim of this study is to develop a predictive model with several explanatory variables that can guide ophthalmologists to make a more objective assessment of the evolution of open-angle glaucoma (OAG) during tertiary prevention. Objectives: The evaluation of risk factors and different predictors of symptom progression between patients with POAG and non-glaucoma patients (NG), as well as between primary open-angle glaucoma with high intraocular pressure (POAG) and primary open-angle glaucoma with normal intraocular pressure (NTG), in tertiary prophylactic activities. Methods: This research is an analytical epidemiological study of a prospective cohort. For the study, we took into account personal medical history, physical ophthalmological examination, intraocular pressure (IOP) values, and visual field (VF) parameters, examined with the Opto AP-300 Automated Perimeter using the “fast threshold” strategy. The results of gonioscopy were inconsistently recorded; they were not considered in the study due to missing values, the processing of which would have seriously distorted the statistical analysis. Ophthalmological examination was completed with a dichotomous questionnaire entitled “Symptom Inventory”, made according to the accusations of patients resulting from a “focus group” study. The study was carried out in the ophthalmology office within the Integrated Outpatient Clinic of the Emergency Clinical Hospital of Oradea, Bihor County (IOCECHO) between January–December 2021. The threshold of statistical significance was defined for p value < 0.05. The obtained results were statistically processed with specialized software SPSS 22. Results: The study included 110 people, of which 71 (64.54%) had POAG (IOP > 21 mmHg) and 39 people (35.46%) had NTG (IOP < 21 mmHg), the two groups being statistically significantly different (χ2 = 9.309, df = 1, p = 0.002). For the POAG group, glaucomatous loss was early, AD < −6 dB, according to the staging of glaucomatous disease, HODAPP classification. In addition, the groups of POAG and NTG patients was compared with a group of 110 NG patients, these three groups being statistically significantly different (χ2 = 34.482, df = 2, p = 0.000). Analysis of confounding factors (age, sex, residence, marital status) shows a statistically significant relationship only for age (F = 2.381, df = 40, p = 0.000). Sex ratio for the study groups = 5.11 for OAG and =5.87 for NG. After treatment (prostaglandin analogues and neuroprotective drugs) IOP decreased statistically significantly for both POAG and NTG. Conclusions: this study identified possible predictors of OAG, at the 5% level (risk factors and symptoms as independent variables) using a dichotomous questionnaire tool with a complementary role in tertiary prophylactic activities. The implementation of the focus group interview results as a socio-human research technique will be supportive to clinicians.

Correlation between optical coherence tomography angiography macular parameters with optical coherence tomography structural parameters in primary open angle glaucoma (a longitudinal descriptive study)

Background: There is growing evidence indicating that glaucoma pathogenesis is attributed to vascular dysfunction.Aim: compare the macular circulation in normal individuals and glaucomatous patients in the superficial as well as the deep retinal plexuses, to determine and characterize macular circulation deficits in glaucoma along with correlating them with structural macular OCT parameters Methods: descriptive study included 100 eyes of 100 participants who were selected randomly from attendants of ophthalmology outpatient clinic in Beni-suef university hospital Participants were subjected to 24-2 SITA- standard automated VF test using SAP ,OCT ONH examination and OCTA (Macula) Results: IOP showed significant negative moderate to strong linear correlation with all the Macular Parameters in Glaucoma Participants. These correlations were highly significant; (p-values &lt;0.001). All measurements of superficial and deep macular venues plexuses by studied macular OCTA was statistically significantly lower in glaucomatous as compared to non-glaucomatous participants; (p-values &lt;0.001). Conclusion: There was a reduction in VD in particular that of superficial layer in POAG patients in macular region, according to OCTA measurements. Glaucomatous eyes have a significantly sparser superficial VD in the macula when compared to healthy eyes, and these VD assessments are significantly accompanied by the severity of VF destruction and OCT structural affection.

Cholesterol homeostasis regulated by ABCA1 is critical for retinal ganglion cell survival.

Genome-wide association studies have suggested a link between primary open-angle glaucoma and the function of ABCA1. ABCA1 is a key regulator of cholesterol efflux and the biogenesis of high-density lipoprotein (HDL) particles. Here, we showed that the POAG risk allele near ABCA1 attenuated ABCA1 expression in cultured cells. Consistently, POAG patients exhibited lower ABCA1 expression, reduced HDL, and higher cholesterol in white blood cells. Ablation of Abca1 in mice failed to form HDL, leading to elevated cholesterol levels in the retina. Counting retinal ganglion cells (RGCs) by using an artificial intelligence (AI) program revealed that Abca1-deficient mice progressively lost RGCs with age. Single-cell RNA sequencing (scRNA-seq) revealed aberrant oxidative phosphorylation in the Abca1-/- retina, as well as activation of the mTORC1 signaling pathway and suppression of autophagy. Treatment of Abca1-/- mice using atorvastatin reduced the cholesterol level in the retina, thereby improving metabolism and protecting RGCs from death. Collectively, we show that lower ABCA1 expression and lower HDL are risk factors for POAG. Accumulated cholesterol in the Abca1-/- retina causes profound aberrant metabolism, leading to a POAG-like phenotype that can be prevented by atorvastatin. Our findings establish statin use as a preventive treatment for POAG associated with lower ABCA1 expression.

Analysis of nestin protein in the aqueous humor as biomarker of open angle glaucoma

BackgroundPrimary open angle glaucoma (POAG) is a progressive optic nerve degeneration, leading to irreversible visual damage. Alterations of the aqueous humor (AH), the biological fluid filling both the anterior and the posterior chambers of the eye, play a pathogenic role in POAG. AH protein composition is altered during glaucoma progression. Nestin protein was found to be differentially expressed in the AH of glaucomatous patients compared to unaffected matched controls. Methods: Nestin was analyzed by an open quartz crystal microbalance (QCM) in the AH of 21 glaucomatous patients compared to nine unaffected controls. The surface of the electrode used in the QCM was coated with an analyte-specific recognition layer. Results: Positive nestin values were recorded in the AH collected from POAG patients; negative values of nestin detection were obtained by analyzing the AH collected from non-POAG glaucomatous patients and unaffected controls. Conclusion: The present study proposes and validates a new clinically applicable approach to analyze biological markers in AH for POAG diagnosis.

ASSOCIATION BETWEEN PLATELET AGGREGATION PARAMETERS AND PRIMARY OPEN ANGLE GLAUCOMA

Glaucoma is the leading cause of irreversible blindness in the world. Being a progressive optic neuropathy, understanding multiple mechanisms playing a part in its progression is of vital importance. Among them, vascular theory states that it occurs as a consequence of insufcient blood supply. To know if this insufciency occurs due to thrombosis in the blood vessels, platelet aggregation parameters can be used as a guide. Aims: To compare the association between platelet aggregation parameters in patients with and without primary open angle glaucoma and also to co-relate it with the severity of glaucoma. Design: Randomized, Cross-sectional, hospital-based observational study. Methods: A total 53 consecutive patients with POAG and 53 controls were recruited in the study. The cases were grouped as mild, moderate and severe based on the clinical optic nerve head ndings and mean deviation (MD) value of visual elds. In bilateral cases, the eye with worse MD was selected. Complete blood count was done to assess Platelet count (PLT), Platelet distribution width (PDW), Plateletcrit (PCT), Mean platelet volume (MPV). These platelet aggregation parameters were compared between the two groups. Results: In the POAG group, PDW (16.29±1.10 fL) and MPV (8.48±0.83 fL) values were signicantly higher (p &lt;0.05) than those of the control group (PDW 15.85±0.74 fL, MPV 8.17±0.76 fL). In POAG patients, PLT counts were lower (276.1±43.5) compared to controls (291.2±53.0) though not statistically signicant. MPV (8.80±0.55), PDW (16.65±1.25) was highest in the moderate group but no statistically signicance found. Conclusions: PDW and MPV values were found to be higher in POAG patients, suggesting the possibility of platelet activation and hence increased platelet aggregation leading to insufcient blood supply to the optic nerve head and hence development of POAG. Role of antiplatelet drugs in delaying the development of glaucoma can be considered based on the above evidence.

Current situation of minimally invasive glaucoma surgery in Brazil

GONIOSCOPY-ASSISTED TRANSLUMINAL TRABECULOTOMY Described in 2014, the GATT involves the introduction of a microcatheter circumferentially running through Schlemm’s canal, creating a 360o ab interno trabeculotomy.() Alternatively, suture with Prolene® or Nylon 5-0 or 6-0 with a tip modified by cautery can be used, reducing costs, and maintaining safety profile and results.() Grover et al.()followed up 198 patients undergoing GATT for 24 months, and found a mean IOP reduction by 9.2 mmHg in POAG patients, and a mean reduction of 1.43 [...]

Factor analysis of the risk of developing primary open-angle glaucoma

To assess the significance of risk factors in POAG development based on multivariate analysis of variance. The study included 348 patients (348 eyes) with stages I-IV POAG aged 45 to 87 years, who underwent a comprehensive ophthalmological and genetic examination. The control group consisted of 48 individuals (48 eyes) without glaucoma, matched with POAG patients in terms of gender and age. Ophthalmological examination of patients was carried out in 2013-2019 at the «Optimed» Laser Eye Surgery Center in Ufa, molecular genetic research - at the Institute of Biochemistry and Genetics of the Ufa Federal Research Center of the Russian Academy of Sciences. The results were statistically processed using the IBM SPSS Statistics v.21 program. The multivariate analysis employed the principal component method. Correlations between patient parameters and main factors were calculated using the method of rotation - varimax. The significance level was taken equal to 0.05 when testing statistical hypotheses. Factor analysis was used to rank the factors associated with POAG development, the following variables were attributed to the most significant indicators of high risk (16.75% of the total variance) of developing the disease: age, comorbidity index, cataract, pseudoexfoliative syndrome, pigmentation intensity in the anterior chamber angle. Factor analysis is a multivariate method of mathematical analysis that allows studying the role of the risk factors for POAG development and their association with the disease, which contributes to early diagnosis and identification of clinical and functional features of the disease.

Association of rs 10038177 and rs 1971050 Polymorphism of WDR 36 Gene with Clinical Profile in POAG Patients

Aim: To study WDR36 gene polymorphism (rs10038177 , rs1971050) and its association with clinical parameters in patients of primary open angle glaucoma. Methods: A cross sectional study conducted on 105 cases of POAG to study its association with WDR36 gene polymorphisms (rs 10038177, rs 1971050). The study subjects underwent complete ophthalmic examination, slit lamp examination, IOP measurement by Goldmann’s Applanation Tonometer, gonioscopy, fundus evaluation by 90D lens. RNFL thickness was measured using cirrus 500 OCT by Carl Zeiss. Peripheral blood samples were collected in EDTA-anticoagulant tubes, then DNA was extracted using the genomic DNA extraction and genotyped by PCR-RFLP by using (AluI) enzyme.Data analysis by SPSS, version 21.0. Chi-square and Independent sample ‘t’-tests used for comparison. Results: The association of genotypic expression of rs10038177 polymorphism with different clinical variables in POAG patients, and the mean IOP (31.66 + 5.88) and CDR (0.72+ 0.15) for heterozygous genotype TC was significantly higher as compared to homozygous de33eeeee4(p&lt;0.05) while in rs1971050 polymorphism, Diabetic history was significantly higher in genotype TC(60%)(p=0.012) as compared to genotype TT (19.1%). Conclusion: Our study shows that WDR 36 polymorphism (rs10038177) and (rs1971050) have an association with higher IOP and RNFL thinning which could be the underlying factors in pathogenesis and progression of POAG.

Association between a SLC23A2 Gene Variation, Plasma Vitamin C Levels, and Risk of Different Diseases

Background: Vitamin C is an important plasma water-soluble antioxidant that plays an essential role in the absorption of iron, detoxification of exogenous compounds, and remaking vitamin E for the protection of lipid membranes. In addition, vitamin C is essential in the synthesis of collagen. Vitamin C concentrations of plasma are determined by dietary intake and genetic factors. Ascorbic acid is the functional form of vitamin C, which is transported into the cell through sodium vitamin C transporters (SVCTs). There are two forms of SVCTs which are SVCT1 encoded by the SLC23A1 gene and SVCT2 encoded by the SLC23A2. The SLC23A2 gene locus on human chromosome 20P12. It expresses in most human tissues, except lung and skeletal muscle that it is important in regulating the intracellular concentration of ascorbic acid to protect the cell from oxidative stress and promote type 1 collagen maturation. Maintaining proper concentrations of plasma and cellular vitamin C concentration is important for the normal metabolic function of the body and preventing several diseases. In the contrast, a low concentration of vitamin C caused by SLC23A2 variation can cause several chronic diseases. Our systematic review discusses four diseases related to the variation of SLC23A2 gene and plasma vitamin C levels which are glaucoma, acute coronary syndrome among women, gastric cancer, and HPV16-associated head and neck cancer.&#x0D; Methods: By using NCBI databases, specifically GenBank to analyze DNA sequence and mRNA sequence of SLC23A2 gene. GenBank file format was helpful to extract an accession number of the gene, number of amino acids, number of exons and introns, and length of nucleotides. FASTA format was also useful to retrieve the nucleotide sequence and get the function of the protein. BLAST was used to compare the protein product of the SLC23A2 gene between humans and Macaca mulatta (Rhesus monkey).&#x0D; Results: the accession number of the SLC23A2 gene was NC_000020.11, the number of exons found was 18, and the gene was located in chromosome 20. This gene encodes one of the two required transporters, and the encoded protein accounts for tissue-specific uptake of vitamin C. This gene had an official symbol of SLC23A1. And they found a significant association between the single-nucleotide polymorphism (SNP) rs1279683 (A &gt; G) in SLC23A2 and an increased risk of POAG in homozygous G allele (GG) carriers. Also, POAG patients with this SNP appear to have a significantly lower level of plasma vitamin C compared to other genotypes. Finally, many organisms have the same gene, such as dogs, mice, rats, and chickens.&#x0D; Conclusion: there is a significant association between SLC23A2 gene mutation, increased risk for vitamin C deficiency, and several diseases. SNP in the SLC23A2 gene was significantly associated with a higher risk of POAG in GG allele carriers as well as lower plasma vitamin C concentration.

Comparison of inner macular thickness and superficial macular capillary vessel density acquired using classic and high-definition optical coherence tomography angiography scans

Background: In ophthalmology, thickness and vessel density (VD) measurements for the 6 x 6 mm inner macular retinal area have received increasing attention in glaucomatous progression research. For this area, the Angiovue optical coherence tomography system introduced a 304 x 304 A/B scans function (classic Angio Retina scan) in 2014, and a 400 x 400 A/B scans function (high-definition [HD] Angio Retina scan) in 2017. These scan types cannot be used in combination for the software provided for progression analysis.Purpose: Since losing data for 3 years may negatively influence progression analysis, we investigated whether clinically significant differences exist between consecutive measurements acquired with these scan types on the same eyes.Methods: As a part of our noninterventional prospective glaucoma imaging study, primary-open-angle glaucoma patients (POAG group), and ocular hypertensive and healthy control participants (structurally undamaged group) were imagedusing both the classic and the HD Angio Retina scans, respectively, without changing the patients’ position. High-quality images were obtained on 12 POAG eyes of 12 consecutive POAG patients, and 10 healthy and ocular hypertensive eyes of 10 consecutive participants before the data collection had to be suspended due to the new coronavirus epidemic.Results: For Early Treatment Diabetic Retinopathy Study image area, the mean difference (classic minus HD value) was 0.02 ± 0.37 μm for inner retinal thickness (P = 0.869) and 0.33 ± 1.33 % (P = 0.452) for superficial capillary VD in the structurally normal group (between-methods difference: ≤ 0.8% of the respective normal value). In the POAG group, the corresponding figures were -0.07 ± 1.22 μm for inner retinal thickness (P = 0.854; between-methods difference: 0.6% of the normal value) and 1.12 ± 2.58 % for superficial capillary VD (P = 0.158; classic scan value minus HD scan value: 1.12 ± 2.58 %; 2.3% of the normal value).Conclusion: Our results suggest that combined use of thickness and VD values for structurally normal eyes and thickness values for POAG eyes derived from classic and HD scans, respectively, for progression analysis can be reasonable since the differences between the corresponding values are small. However, combining the corresponding VD parameters for POAG eyes is useful only when the follow-up time before the scan type change is long enough to counterbalance the effect of the change on the result.

Comparitive study between normal tension glaucoma and primary open-angle glaucoma

The study is conducted to determine the functional and structural differences between NTG and POAG, to assess the rate of conversion of NTG into POAG and its early intervention. It is a hospital based prospective, cross-sectional study of 56 NTG and 56 POAG patients. History was taken and comprehensive ophthalmic examination with glaucoma work up was done.Majority of the patients belonged to the age group between 51 and 60 years i.e. 48.2% in NTG and 62.5% in POAG. Majority of the NTG patients i.e. 33 (58.9%) were females while 41(73.2%) were males in POAG. 40% of NTG patients had systemic association like bronchial asthma, diabetes, hypertension, ischemic heart disease and migraine. There was no significant difference in CDR between two groups. Inferior &amp; temporal neuroretinal rim thinning was more common in NTG. While bipolar thinning &amp; superior rim thinning was more common in POAG. There is significantly more thinning of RNFL in POAG than NTG. The mean deviation (MD) &amp; pattern standard deviation (PSD) in visual fields between NTG &amp; POAG showed no significant difference. Whereas the field loss was near centre of fixation in NTG group compared to POAG which was diffuse. These differences between NTG and POAG suggest that the pathogenesis of NTG includes IOP and IOP independent risk factors, while IOP is the main risk factor in POAG. The parameters assessed determine the risk and progression of NTG to POAG.

Correlation of NUCB2/Nesfatin-1 with Cytokine Levels in Primary Open-Angle Glaucoma.

PurposeNesfatin-1 is produced in various tissues of the body including the hypothalamus. Neuroprotective properties of the neuropeptide hormone Nesfatin-1 were recently described. The aim of the study was to analyze the molecule Nesfatin-1 as a possible biomarker in POAG with neuroprotective properties pointing out the retinal-hypothalamic axis as target site in POAG and to obtain a molecular signature of cytokines in POAG as neuroinflammatory processes are a key factor of glaucoma development.MethodsIn this study, n=35 patients with moderate and advanced POAG (mean age 65.0y, IOP 13.9±3.0mmHg) and n=35 healthy controls (mean age 51.6y, IOP 14.3±2.7mmHg) were included. Clinical parameters including IOP, cup to disc ratio (CDR), glaucoma medication and retinal nerve fiber layer thickness (RNFL) were recorded. Plasma was collected for NUCB2/nesfatin-1 measurement using a Nesfatin-1 ELISA and for detection of 13 inflammatory cytokines using a multiplex bead-based immunoassay (MagPix). Multiple linear regression analysis was performed to adjust for confounding factors.ResultsSex-independent or sex-dependent variables showed no significant differences in the Nesfatin-1 level (p>0.05). As a trend, an increase in NUCB2/nesfatin-1 in male glaucoma patients was found. Increased concentrations of 11 cytokines (GM-CSF, Interferon-γ, Interleukin-1β, IL-2, 4, 5, 6, 7, 10, 12 and TNF-α) were detected in POAG. The female glaucoma patients demonstrated elevated cytokine concentrations compared to male patients. NUCB2/nesfatin-1 showed a significant correlation to IL-2 and IL-13 levels in POAG. Stepwise multiple regression analysis showed no difference in NUCB2/nesfatin-1 level between POAG and healthy controls after adjusting for sex and age (all p>0.05).ConclusionAs a trend, male POAG patients showed increased plasma NUCB2/nesfatin-1 levels. We further found inflammation as contributing factor to the pathogenesis of glaucoma, with a greater inflammatory response in women.

Laser in Glaucoma and Ocular Hypertension Trial (LIGHT) in China – A Randomized Controlled Trial: Design and Baseline Characteristics

To describe the baseline characteristics of a trial to evaluate whether selective laser trabeculoplasty (SLT), as a first-line treatment, provides superior economic and health-related quality of life outcomes to medical treatment in China. The LiGHT China trial is an unmasked, single-center, pragmatic, randomized controlled trial. A total of 771 previously undiagnosed patients with primary open angle glaucoma (POAG, 622 patients) or ocular hypertension (OHT, 149 patients) at Zhongshan Ophthalmic Center were recruited from March 2015 to January 2019. Subjects were randomized to SLT-1st (followed by medication then surgery when required) or Medicine-1st (medication followed by surgery when required). The primary outcome was health-related quality of life (HRQL). The secondary outcomes were clinical outcomes, cost, cost-effectiveness, Glaucoma Utility Index, Glaucoma Symptom Scale, visual function, and safety. The mean age of POAG patients was 49.8 years and 38.8 years for OHT. The median intraocular pressure was 20 mm Hg for the 1,105 POAG eyes and 24mmHg for the 271 OHT eyes. POAG eyes had thinner central cornea thickness (CCT, 536 µm) than OHT eyes (545 µm). Median mean deviation of the visual field in POAG eyes was -4.2 dB. Median refractive error was -1.5 D for OHT eyes and -1.25D for POAG eyes. There was no difference between POAG and OHT patients on baseline scores of GUI, GSS and VF-14. The difference between OHT and POAG on the EQ-5D-5L was 0.024. Compared with participants in the LiGHT UK trial, participants in this trial were younger, more myopic and had more severe visual field defects.

STUDY ON EFFICACY AND SAFETY OF RIPASUDIL HYDROCHLORIDE IN TREATMENT OF NEWLY DIAGNOSED PRIMARY OPEN ANGLE GLAUCOMA

Aim: The study aims at evaluating the lowering effect of Intraocular pressure (IOP) and tolerability of Ripasudil(0.4%) ophthalmic solution, a selective rho kinase1 inhibitor, as monotherapy in newly diagnosed primary open angle glaucoma patients. Background: Glaucoma is a chronic progressive optic neuropathy causing irreversible blindness around the world. Current treatment strategy stems from concept of lowering IOP, which is a key modiable risk factor. Ripasudil also known as K 115,is the world's rst Rho-associated coiled-coil-containing protein Kinase 1(ROCK1) inhibitor that lowers IOP by directly acting on trabecular meshwork,increasing conventional outow. Methods: This prospective, interventional study included 53 patients of newly diagnosed primary open angle glaucoma.0.4% Ripasudil ophthalmic solution was instilled twice a day as the primary treatment. The primary endpoint was the degree of IOPreduction after 6 months of treatment, whereas the secondary end points were percentage of patients reaching the predened target IOP and incidence of adverse effects. Results: We examined 53 eyes of 53 primary open angle glaucoma patients. The IOP reduction (relative percentage IOP reduction)from baseline was -2.3 mm Hg(-1.7 to -2.9 mm Hg,95%condence interval ,P&lt;0.001).The predetermined target IOPwas achieved by 54.7% population(29 among 53 patients).The most common adverse effects noted were conjunctival hyperaemia (54.7% of patients),allergic conjunctivitis(35.8% of patients) punctate keratitis(11.32% of patients), blepharitis(15.09% of patients), headache(24.5% of patients), bradycardia(9.43% of patients). Conclusion: Administration of 0.4% Ripasudil ophthalmic solution monotherapy revealed IOPlowering effect and acceptable safety prole in POAG patients. As ROCK inhibitors are novel anti-glaucoma drug, more data and studies are needed to establish best practices for the treatment of the patients.

Correlation of contrast sensitivity with the severity of primary open angle glaucoma

Aims: To assess the contrast sensitivity (CS) in different stages of primary open angle glaucoma and to correlate it with the severity (mild, moderate & severe) of glaucoma. Materials and Methods: This prospective randomized study was conducted at Sapthagiri institute of medical sciences and research centre, Bangalore between June 2017 & December 2017. A total of 100 eyes of 55 individuals aged 25-80 years diagnosed with POAG were enrolled in this prospective study. Selected subjects underwent detailed ophthalmic examination including ocular history, slit lamp examination, objective & subjective refraction (if required) to obtain best corrected visual acuity (BCVA) on Snellen visual acuity chart and dilated fundus evaluation using indirect ophthalmoscopy. Eyes with clear media and ?BCVA 6/60 were included and contrast sensitivity was measured using Pelli Robson chart at 1 meter distance. HFA report of included subjects were collected from Glaucoma department to classify them in to mild, moderate and severe groups according to their visual field findings (pattern deviation of HFA report). Classification was done according to International statistical classification of disease and related health problem (ICD 10). One way ANOVA and t-test was used to analyze the data. Results: There was 36% mild, 26% moderate and 38% severe cases of POAG classified according to ICD 10. The mean value of contrast in mild, moderate and severe POAG was 1.4341, 1.3267 and 1.1326 respectively. An analysis of variance tested whether there were significant difference in contrast sensitivity among mild, moderate and severe POAG. Results indicated that these means differed significantly p < 0> Conclusion: There was decrease in contrast sensitivity with the severity of POAG. Thus the contrast sensitivity testing should be made mandatory in evaluating POAG patients which could help in screening/diagnosis (early detection) and to assess the progression of the disease as well as response to the tre

OCT angiography analysis of retinal vessel density in primary open-angle glaucoma with and without Tafluprost therapy

BackgroundPrimary open-angle glaucoma (POAG) is a progressive neurodegenerative disease which leads to irreversible blindness. An elevated intraocular pressure (IOP) is considered to be the main risk factor for the disease progression. It is known that retinal blood flow is altered in POAG eyes. Tafluprost, a prostaglandin analogue which lowers the IOP, has shown to also improve the retinal blood flow in animals.MethodsThe current study therefore evaluated the retinal vessel density in the peripapillary and macular region of POAG patients with normal IOP treated with topical Tafluprost (n = 20) compared to surgically treated patients with normal IOP (n = 22) using optical coherence tomography angiography (OCT-A). The retinal flow density was obtained after binarisation and evaluated in five sectors.ResultsThere was a significantly higher peripapillary flow density in all sectors in Tafluprost treated eyes when compared to post-surgery eyes. The flow density in the inferior sector of the superficial plexus in the macular region was also significantly higher in the Tafluprost group.Conclusions: These results indicate that Tafluprost not only lowers IOP, but may also enhance retinal blood flow in POAG patients with a normal IOP.

Efficacy of corneal shape index in the evaluation of ocular hypertension, primary open-angle glaucoma and exfoliative glaucoma.

The aim of the present study is to calculate Concavity Shape Index (CSI) in patients with POAG and exfoliative glaucoma (XFG) and correlate CSI with the severity of glaucoma, comparing to control and ocular hypertension (OHT) patients. This was a cross‑sectional study with 146 eyes/146 subjects: 37 healthy eyes, 23 eyes with OHT and 86 glaucoma eyes (70 with POAG, 16 with XFG). The severity of glaucoma was scored with the Glaucoma Staging System 2 (GSS2). Corvis ST® was used to calculate CSI. Central corneal thickness (CCT) was significantly thinner in POAG (526 ± 40.0 µm) and XFG (520 ± 38.2 µm) than control group (553 ± 28.8 µm). CSI had no significant differences between the groups. XFG had a higher mean of GSS 2 (2.42 ± 1.38) than POAG (1.87 ± 1.55) and OHT (1.87 ± 1.55). OHT had a significantly less deformable cornea than: control (higher A1 length, lower A1 velocity, higher A2 velocity), POAG (higher A1 length, lower A1 velocity, lower deflection amplitude at highest concavity), and XFG group (lower A1 velocity, lower deflection amplitude at highest concavity), which was independent of age and CCT. No significant correlation was found between GSS 2 and CSI. OHT patients had stiffer corneas (less deformed by the air puff) when compared to control, POAG or XFG patients. A less deformable cornea could potentially be related to a more resistant LC/peripapillary sclera. As such, this would result in a lesser optic nerve susceptibility to IOP damage.

Juvenile-onset Open-Angle Glaucoma at the University Teaching Hospitals - Eye Hospital, Lusaka Zambia

Purpose: To demonstrate the socioeconomic, demographic and clinical characteristics associated with patients of juvenile-onset open- angle glaucoma (JOAG) at the University Teaching Hospitals Eye Hospital (UTHs - EH).Methods: This was a cross-sectional survey for Juvenile Open Angle Glaucoma (JOAG) conducted at the UTHs - EH in, Lusaka, Zambia from January to December 2013. All participants aged between 18 and 39 years had a full ocular examination after capturing demographic and socioeconomic information. The ocular examination included visual acuity, intraocular pressure (IOP) and cup disc ratio (CDR) and tests performed were central corneal thickness (CCT) and visual fields. Severity was graded based visual field (VF) in the worse eye using the advanced glaucoma intervention study score. Univariate and multivariate logistic regression, stratified by age group and gender, was used to determine the association between demographic factors and JOAG and between clinical factors and JOAG.Results: Of the 1625 patients recruited for the study, 309 were POAG patients. Of the 309 POAG patients, 140 aged 20 to 39 years old had bilateral JOAG. The distribution of the 140 participants was 98 (70.9%) females and 42 (29.4%) males. Thirteen (9.3 %) were aged 20 – 24 years, 29 (20.7%) 25 – 29 years, 44 (31.4%) 30 – 34 years, and 54 (38.6%) 35 – 39 years. The mean age of the patients was 25.1 ± SD 8.7 years. The prevalence of JOAG was 8.6%