POAG Patients Research Articles

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 includedvisual 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, wasused 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% (140/1625) distributed as 2.6% (95% CI 1.3, 3.9) males and 6.0% (95% CI 4.7, 9.2) females. There was a female preponderance of (71.2% vs. 28.8%; OR 2.98, 95% CI 2.3, 6.7, p=0.021). Eighty-five (60.7%) had complained of poor vision and 24 (17.1%) of eye pain. However, 24 (17.1%) presented with no definite symptoms. Patients with a positive family history presented 3.7 years earlier (P = 0.034, CI; 1.37-7.9) compared to those without a family history. Lower socioeconomic status (Odds ratio [OR] 3.5, P = 0.013, CI: 1.2-17.2), and higher IOP (OR 6.7, P = 0.002, CI: 2.6-21.8) were associated with severe glaucomatous visual field defects. High myopia (-6.47 ± 5.00 Diopters) was present in 70.9% of patients. The patients with myopia also had a severe elevation of IOP of (35.8 ±18.5 mmHg).
 Conclusions: The study found a high prevalence of JOAG at 8.6%. The patients with JOAG presented late with advanced disease and high IOP. Clinical, socioeconomic, and demographic factors are contributory to the severity of JOAG among JOAG patients.
 Recommendation: Early detection of cases during eye health care outreach programmes such as school and community screening of children and adults could be of great benefit in creating awareness, d ema n d , e a r l y d e t e c t i o n a n d p r omp t commencement of treatment. Glaucoma should no longer be considered a condition of the people aged 40 years and above.

A pilot study to evaluate the levels of aqueous humor trace elements in open-angle glaucoma

BackgroundPrimary open angle glaucoma (POAG) is the most common form of chronic, progressive optic neuropathies characterized by slow degeneration of the retinal ganglion cells and their axons, resulting in visual field loss. Risk factors for this disease are elevated intraocular pressure (IOP), increased age, European and African ethnicity, family history, myopia and decreased corneal thickness. In addition, studies indicated that levels of trace elements are also significantly related to the POAG. MethodThe association between toxic and essential elements and POAG was explored in a population-based case–control study in the Sardinia Island (Italy). The aqueous humor levels of Al, Cd, Cu, Fe, Hg, Mn, Ni, Pb and Zn were measured in 25 POAG patients compared to 20 age- and gender-matched healthy controls by sector field inductively coupled mass spectrometry. Risk factors as gender, age and increased IOP were also explored. ResultsThe concentrations of Fe, Hg and Zn were significantly higher in POAG patients than in control subjects, showing these elements as possible determinants in POAG development or degeneration. Other findings were the increased Cu and Fe levels in glaucomatous patients with age less than 70 years. Levels of Ni were found elevated in POAG females. Mercury accumulated more in POAG females, in patients over 70 years and in those with higher levels of IOP in the left eye. Moreover, the positive associations CuFe and Mn-Zn may indicate synergistic effects of elements. ConclusionsAltogether, these findings suggested a multifactorial role in the risk for POAG disease. The present study documented the levels of trace elements in aqueous humor of Sardinian POAG patients for the first time.

To evaluate the role of oxidative stress in developmentof primary open angle glaucoma

Primary open angle glaucoma is a chronic optic neuropathy with possible involvement of oxidative stress in its pathogenesis. The present study was conducted to evaluate the role of oxidative stress in terms of lipid peroxide (LPO) and the protective role of antioxidant enzymes catalase (CAT), superoxide-dismutase (SOD) and glutathione peroxidase (GPX) in patients of primary open angle glaucoma. A total of 120 patients were enrolled. After taking informed consent, 5 ml of venous blood was taken under aseptic conditions in EDTA tube. These samples were transported from Eye OPD to Laboratory in icebox maintaining temperature for enzymatic activity of enzymes in blood samples.The blood was centrifuged, plasma was separated and was used for estimation of lipid peroxide (LPO). RBC lysates were prepared for estimation of antioxidant enzymes namely; catalase (CAT), superoxide dismutase (SOD), glutathione peroxidase (GPx). A total of 120 patients were enrolled. There was no significant difference in LPO levels of POAG patients and controls. No statistically significant difference was observed in the levels of SOD and catalase. There was a significantly raised value of GPx in POAG patients but since SOD activity was normal, we can conclude that the SOD level was sufficient to meet the above exigency. Oxidative stress is not the only cause for development of primary open angle glaucoma.

Identification of lncRNA\u2013miRNA\u2013mRNA regulatory network associated with primary open angle glaucoma

BackgroundPrimary open angle glaucoma (POAG) is a multifactorial disorder characterized by a progressive permanent degeneration of retinal ganglion cell (RGCs) death. An increasing number of studies have suggested that long noncoding RNAs (lncRNAs) have the ability to regulate gene expression; however, thus far, the mechanisms and functions of lncRNAs in the development of POAG are still unclear.MethodsUsing the data from Gene Expression Omnibus (GEO), differentially expressed lncRNAs and differentially expressed mRNAs between POAG patients and controls were identified. Then, the lncRNA–miRNA–mRNA competing endogenous RNA (ceRNA) network was constructed, and the key lncRNAs in POAG were identified. A Gene Ontology (GO) analysis and a Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analysis were performed to assess the enriched biological functions of mRNA in the ceRNA network.ResultsDuring this study, a POAG-related ceRNA network with 37 miRNA nodes, 248 lncRNA nodes, 178 mRNA nodes, and 1985 edges was constructed. In addition, four lncRNAs (DNAJC27-AS1, AF121898, OIP5-AS1, and SNX29P2) were established as hub RNAs in this ceRNA network. The functional assay showed that 18 GO terms and 17 pathways were enriched.ConclusionThis study provides novel insights into the lncRNA-related ceRNA network in POAG, and the four lncRNAs were identified in the development of POAG.

Autoantigens in the trabecular meshwork and glaucoma-specific alterations in the natural autoantibody repertoire.

ObjectivesPrimary open‐angle glaucoma (POAG) is a neurodegenerative disorder leading to a gradual vision loss caused by progressive damage to the optic nerve. Immunological processes are proposed to be involved in POAG pathogenesis. Altered serological autoantibody levels have been frequently reported, but complete analyses of the natural autoantibodies with respect to disease‐related alterations are scarce. Here, we provide an explorative analysis of pathways and biological processes that may involve naturally immunogenic proteins and highlight POAG‐specific alterations.MethodsMass spectrometry‐based antibody‐mediated identification of autoantigens (MS‐AMIDA) was carried out in healthy and glaucomatous trabecular meshwork (TM) cell lines, using antibody pools purified from serum samples of 30 POAG patients and 30 non‐glaucomatous subjects. Selected antigens were validated by protein microarray (n = 120). Bioinformatic assessment of identified autoantigens, including Gene Ontology (GO) enrichment analysis and protein–protein interaction networks, was applied.ResultsOverall, we identified 106 potential autoantigens [false discovery rate (FDR) < 0.01], from which we considered 66 as physiological targets of natural autoantibodies. Twenty‐one autoantigens appeared to be related to POAG. Bioinformatic analysis revealed that the platelet‐derived growth factor receptor beta (PDGFRB) pathway involved in TM fibrosis was particularly rich in POAG‐related antigens. Antibodies to threonine‐tRNA ligase (TARS), component 1 Q subcomponent‐binding protein (C1QBP) and paraneoplastic antigen Ma2 (PNMA2) showed significantly (P < 0.05) higher levels in POAG patients as validated by protein microarray.ConclusionThis study provides new insights into autoimmunity in health and glaucoma. Bioinformatic analysis of POAG‐related autoantigens showed a strong association with the PDGFRB pathway and also increased levels of PNMA2, TARS, and C1QBP autoantibodies in the serum of POAG patients as potential glaucoma biomarkers.

Signs of proliferative process after laser treatment of advanced glaucoma

To evaluate the condition of SFOT in dynamics with Visante OCT after one-step combined laser technique consisting of modified selective laser activation of the trabecula (MSLAT) and DGP in advanced POAG patients with normalized IOP who have pronounced pigmentation of the trabecular meshwork and stage II pseudoexfoliation syndrome (PES). OCT scans of 117 patients (117 eyes) were analyzed before laser treatments and after 1, 3, 6, 12 and 24 months. The study included 62 patients (62 eyes) comprising the main group who underwent MSLAT + DGP, and the control group consisting of 55 patients (55 eyes) who only underwent DGP. Visante OCT scans revealed that parameters of the filtration bleb (FB) and intrascleral cavity (ISC) in the main study group were more stable than in the control group during the whole follow-up. In the main study group there were less incorporations in the ISC and they had lower optical density, compared with the control group where there were denser incorporations in the ISC which gradually increased in count. According to Visante OCT, the growing count and the increase in density of incorporations in the ISC can be defined as adverse signs of an active proliferative process in SFOT. A one-step MSLAT with DGP help achieve both a long-lasting hypotensive effect, and decrease of active proliferative process signs in SFOT.

Trace elements in glaucoma – The impact of analytics

AbstractEye diseases, such as glaucoma are leading causes of irreversible vision loss in industrialized countries. Eye diseases have multifactorial pathogenesis, where heavy metal body burden and/or trace element misbalances are accepted causes aside from genetic factors or intraocular pressure in glaucoma. Heavy metals and misbalances in redox‐active trace elements are prone to affect eye‐related health via increased oxidative stress. In this study trace elements and heavy metals were analyzed in aqueous humour samples by Flow‐Injection (FI)‐Inductively Coupled Plasma Mass Spectrometry. The FI‐mode was used to adopt sample introduction to the very low sample volume available. Samples were analyzed in triplicates using standard mode (best sensitivity for Co, Cd, Hg, Pb), dynamic reaction cell (DRC) mode with ammonia as reaction gas (interference elimination best for Mn, Fe Cu, Zn) and DRC with methane as reaction gas for Se. 5‐point calibration curves in the ranges 0‐1000 ng/l for Cd, Hg, Mn, Pb, Se or 0‐100 µg/l for Cu, Fe, Zn showed R2 = 0.989 for Zn and R2 better than 0.999 for the other elements. Analysis of glaucoma patients revealed an unchanged selenium aqueous humor level of POAG patients compared to controls. However, age‐group and sex dependent trends were seen, i.e. a slight increase for the selenium quantiles in POAG and PEXG patients (age 47–60 years), decrease for the first selenium quantile (61–68 years) and an increase of the third tertiles for 70–85 years.

Role of matrix metalloproteinase-9 gene polymorphisms in glaucoma: A hospital-based study in Chinese patients.

BackgroundGlaucoma is the irreversible vision loss and contributes second leading cause of blindness worldwide. Matrix metalloproteinase‐9 (MMP‐9) is involved with remodeling and destruction of extracellular matrix. Elevated MMP‐9 levels and various functional variants of MMP‐9 have been associated with glaucoma in different population. In the current investigation, we tested association of MMP‐9 common variants with different clinical categories of glaucoma in Chinese population.Materials and MethodsWe enrolled total of 396 glaucoma patients those reported to hospital comprising of 212 primary angle closure glaucoma (PACG) cases and 184 primary open‐angle glaucoma POAG patients. In addition, 329 normal individuals from similar geographical areas were enrolled as healthy controls. Five common single nucleotide polymorphisms (rs3918242, rs3918254, rs2250889, rs3918249, and rs17576) were genotyped by PCR‐RFLP. Plasma levels of MMP‐9 were quantified by ELISA.ResultsHeterozygotes (GC) and allele “G” for rs2250889 polymorphism were more frequent in PACG cases compared with healthy controls (GC: P < .0001, OR = 2.26; G: P < .0001, OR = 1.19). Similarly, heterozygous mutant and minor allele for rs3918242 polymorphism were more prevalent in POAG in comparison with healthy controls. Interestingly, distribution of rs17576 variant was statistically higher in both PACG and POAG cases than healthy controls. Furthermore, analysis of plasma MMP‐9 with MMP‐9 polymorphisms revealed significant association of rs2250889, rs3918242, and rs17576 with plasma levels of the protein.ConclusionsMMP‐9 mutants are associated with elevated plasma MMP‐9 and predisposed to development of glaucoma.

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.

Can I reach it? A study in age-related macular degeneration and glaucoma patients

ABSTRACTAims: The visual exploration and the ability to correctly locate a target in reaching an object are critical in daily life. We investigate the object reachability judgment in neovascular age-related macular disease (nAMD) and primary open-angle glaucoma patients (POAG). Methods: Sixty-three participants were recruited in 4 groups (15 nAMD, 15 POAG, 18 old controls and 15 young controls). For each trial a cylinder moved between 11 random distances (from the border of their own peripersonal space 0, ±3, ±6, ±, ±12, ±15 cm). Participants had to estimate if they thought that the object was reachable or not. Results: POAG patients estimated that they could reach targets that were farther than their own peripersonal space (increased by 5.8 cm compared to the three other groups: 2.6 cm). The performance of the nAMD group and the normally sighted group were equivalent. Conclusions: The present study highlights the hypothesis of reach and grasps impairments in POAG due to difficulties in the estimation of reachability which is the beginning of any motor action processing. The reachability judgment of the nAMD patients is not affected. We conclude that POAG can modify the perceived peripersonal space of the patients and induce changes in the reachability judgment.

Mitochondrial-Targeted Antioxidants Attenuate TGF-β2 Signaling in Human Trabecular Meshwork Cells.

POAG is a progressive optic neuropathy that is currently the leading cause of irreversible blindness worldwide. While the underlying cause of POAG remains unclear, TGF-β2-dependent remodeling of the extracellular matrix (ECM) within the trabecular meshwork (TM) microenvironment is considered an early pathologic consequence associated with impaired aqueous humor (AH) outflow and elevated IOP. Early studies have also demonstrated markedly elevated levels of oxidative stress markers in AH from POAG patients along with altered expression of antioxidant defenses. Here, using cultured primary or transformed human TM cells, we investigated the role oxidative stress plays at regulating TGF-β2-mediated remodeling of the ECM. Primary or transformed (GTM3) human TM cells conditioned in serum-free media were incubated in the absence or presence of TGF-β2 and relative changes in intracellular reactive oxygen species (ROS) were measured using oxidation-sensitive fluorogenic dyes CellROX green or 6-carboxy-2',7'-dichlorodihydrofluorescein diacetate (carboxy-H2DCFDA). TGF-β2-mediated changes in the content of connective tissue growth factor (CTGF) and collagen types 1α1 (COL1A1) and 4α1 (COL4A1) mRNA or collagens I and IV isoform proteins were determined in the absence or presence of mitochondrial-targeted antioxidants (XJB-5-131 or MitoQ) and quantified by quantitative PCR or by immunoblot and immunocytochemistry. Smad-dependent canonic signaling was determined by immunoblot, whereas Smad-dependent transcriptional activity was quantified using a Smad2/3-responsive SBE-luciferase reporter assay. Primary or transformed human TM cells cultured in the presence of TGF-β2 (5 ng/mL; 2 hours) exhibited marked increases in CellROX or fluorescein fluorescence. Consistent with previous reports, challenging cultured human TM cells with TGF-β2 elicited measurable increases in regulated Smad2/3 signaling as well as increases in CTGF, COL1A1, and COL4A1 mRNA and collagen protein content. Pretreating human TM cells with mitochondrial-targeted antioxidants XJB-5-131 (10 μM) or MitoQ (10 nM) attenuated TGF-β2-mediated changes in Smad-dependent transcriptional activity. The multifunctional profibrotic cytokine TGF-β2 elicits a marked increase in oxidative stress in human TM cells. Mitochondrial-targeted antioxidants attenuate TGF-β2-mediated changes in Smad-dependent transcriptional activity, including marked reductions in CTGF and collagen isoform gene and protein expression. These findings suggest that mitochondrial-targeted antioxidants, when delivered directly to the TM, exhibit potential as a novel strategy by which to slow the progression of TGF-β2-mediated remodeling of the ECM within the TM.

This Issue of Acta

This Issue of Acta

Obstructive Sleep Apnea in Patients With Primary-open Angle Glaucoma: No Role for a Screening Program.

It has been proposed that OSA might be a contributing factor in the development of POAG and by extension that there could be a role for screening people with POAG for OSA. To assess whether the prevalence of OSA among patients with POAG is different from that in people without glaucoma and to examine for associations between apnea-hypopnea index (AHI) and markers of functional and structural changes in POAG. Unselected POAG patients and control subjects were consecutively recruited in a single center. A comprehensive ocular assessment and nocturnal multichannel cardiorespiratory monitoring were performed. Data from 395 participants, 235 POAG patients, and 160 controls were analyzed. The prevalence of OSA was 58% [95% confidence interval (CI), 52-65] in POAG patients and 54% (95% CI, 47-62) in controls, with 22% (95% CI, 16-27) of POAG patients and 16% (95% CI, 11-22) of controls diagnosed with moderate or severe OSA. A total of 160 POAG participants were matched to the controls using propensity score matching. There was no significant difference in OSA prevalence between the matched groups (P=0.91 for AHI≥5 and P=0.66 for AHI≥15). The AHI was not associated with the severity of visual field defect or retinal nerve fiber layer thinning after adjustment for confounders. This study confirms a high prevalence of OSA among patients with POAG which is, however, not higher than in people without glaucoma matched for known OSA risk factors. Our results do not support screening for OSA in patients with POAG.

Associations between TLR4 Polymorphisms and Open Angle Glaucoma: A Meta-Analysis.

Background Previous studies exploring the association between toll-like receptor 4 (TLR4) polymorphisms and open angle glaucoma (OAG) presented inconsistent results. We aimed to investigate the association between TLR4 polymorphisms and OAG. Methods A systematic literature search was conducted in PubMed, EMBASE, ISI Web of Knowledge, and the Cochrane Library up to 31 December 2018. Odds ratio (OR) and 95% confidence interval (95%CI) were calculated, followed by stratification analyses according to ethnicity and glaucoma subtype. Results TLR4 rs7037117 polymorphism had significant associations with increased risk of OAG in allelic model (OR=1.25; 95%CI: 1.09-1.44; P=0.002) and recessive model (OR=1.49; 95%CI: 1.08-2.04; P=0.01). With regard to rs10759930, rs12377632, and rs2149356, the results showed significant increased risks in all genetic models (all P<0.05), whereas, for rs1927914, rs11536889, and rs7045953, no significant associations were identified in any genetic model (all P>0.05). Furthermore, the association of rs1927911 with OAG risk was found to be significant in recessive model (OR=1.34; 95%CI: 1.06-1.71; P=0.02). As for rs4986790 and rs4986791, meta-analyses were not performed due to the limited number of studies and the ethnic differences. Subgroup analysis indicated that the above polymorphisms with significant differences might increase the susceptibility in POAG patients. As for the ethnicity, rs7037117, rs10759930, and rs1927911 might increase the risk in Asians, while rs12377632 and rs2149356 might increase the risk in Asians and Mexicans. Conclusion The meta-analysis highlighted that certain mutations of some TLR4 polymorphisms might increase the susceptibility of OAG. However, TLR4 polymorphisms are still far from being candidate genetic biomarkers for OAG. Additional researches involving larger scale epidemiological studies are warranted to validate our results.

Corneal biomechanics and biomechanically corrected intraocular pressure in primary open-angle glaucoma, ocular hypertension and controls

AimsTo compare the biomechanically corrected intraocular pressure (IOP) estimate (bIOP) provided by the Corvis-ST with Goldmann applanation tonometry (GAT-IOP) in patients with high-tension and normal-tension primary open-angle glaucoma (POAG; HTG...

Association of Gene Polymorphisms With Primary Open Angle Glaucoma: A Systematic Review and Meta-Analysis.

To confirm the association of all reported common polymorphisms with POAG. We searched in PubMed and Web of Science (up to January 10, 2018) for genetic studies of POAG. All case control studies investigating the association between single-nucleotide polymorphisms (SNPs) and POAG risk were included. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated by fixed- or random-effect model. This meta-analysis included 108 case control studies involving 35,389 POAG patients and 51,742 controls. The pooled results showed a significant association between 20 SNPs in 12 genes (148Asp/Glu in APE1 gene; rs449647 in APOE gene; rs1052990 and rs4236601 in CAV1/CAV2 gene; rs1799750 in MMP gene; c.603T3A (Met98Lys) in OPTN gene; rs7081455 in PLXDC2 gene; rs1279683 in SLC23A2 gene; 372 T/C in TIMP1 gene; rs1927911, rs2149356, rs4986791, rs7037117, and rs10759930 in TLR4 gene; rs4656461 in TMCO1 gene; 399Arg/Gln in XRCC1 gene; and rs540782, rs547984, and rs693421 in ZP4 gene) with POAG. Based on the current meta-analysis, we indicate 20 SNPs in 12 genes (APE1, APOE, CAV1/CAV2, MMP, OPTN, PLXDC2, SLC23A2, TIMP1, TLR4, TMCO1, XRCC1, ZP4) as predictive risk factors for POAG. More studies with large sample sizes and various ethnicities are warranted in the future to provide more powerful evidence.

Levels of serum trace elements in patients with primary open-angle glaucoma

PurposeGlaucoma disease is known as multifactorial. Trace elements seemed to be linked via oxidative stress mediated changes to the complex glaucoma pathophysiology. Thus, it was the aim of this study to investigate serum levels of trace elements in primary open-angle glaucoma patients (POAG). Patients and methodsPeripheral venous blood samples were taken from a total of 40 subjects: 22 primary open-angle glaucoma patients (mean age 58.1 ± 13.9, female 8, male 14) and 18 controls (mean age 38.9 ± 11.6, 6 female 6, male 12). Serum samples of cadmium, cobalt, copper, iron, lead, manganese and zinc were analyzed by Inductively-Coupled-Plasma-Optical Emission Spectrometry (Cu, Fe, Zn) and Inductively-Coupled-Plasma-sectorfield-Mass-Spectrometry (Cd, Co, Mn, Pb, Se). Data were analyzed using ANCOVA and presented as log transformed LS-mean. ResultsPatients with POAG had significantly increased serum levels of iron (2.98 ± 0.03 μg/L vs 2.98 ± 0.03 μg/L) when compared to controls, and of cadmium (1.57 ± 0.05 ng/L vs. 1.40 ± 0.06 ng/L) considering the interaction between age and the class variable (control versus POAG). A gender effect was seen for cadmium, cobalt, copper, and iron in controls and POAG patients. Iron concentration was reduced in dependency of age for both genders in normals, however lesser in POAG patients. No difference was seen in serum levels of lead, manganese, and zinc between patients with POAG and controls. ConclusionA significant elevation of serum cadmium and iron levels in POAG patients as well as an additional gender effect of cadmium, cobalt, copper, and iron in normals and POAG patients, may argue for a potential role of these trace elements in the pathogenesis of primary open-angle glaucoma.

Microvascular endothelial function and primary open angle glaucoma.

Purpose:To determine the role of microvascular endothelial dysfunction as risk factor for primary open angle glaucoma.Methods:A cross-sectional study was conducted involving 114 Malay patients with POAG seen at the eye clinic of Hospital Universiti Sains Malaysia. Patients aged between 40 and 80 years who were diagnosed with other types of glaucoma, previous glaucoma filtering surgery or other surgeries except uncomplicated cataract surgery and pterygium surgery were excluded. A total of 101 patients who were followed up for dry eyes, age-related cataracts or post cataracts extraction surgery were recruited as control subjects. Those with family history of glaucoma or glaucoma suspect were excluded. Microvascular endothelial function was assessed using laser Doppler fluximetry and the process of iontophoresis. Iontophoresis with acetylcholine (ACh) and sodium nitroprusside (SNP) was used to measure microvascular endothelium-dependent and endothelium-independent vasodilatations, respectively.Results:In general, POAG patients demonstrated lower ACh% and AChmax values compared with controls. There was significant difference in microvascular endothelial function [ACh%: mean, 95% confidence interval = 503.1 (378.0, 628.3), and AChmax: mean, 95% confidence interval = 36.8 (30.2, 43.5)] between primary open angle glaucoma cases (p < 0.001) and controls [ACh%: mean, 95% confidence interval = 1378.4 (1245.4, 1511.3), and AChmax: mean, 95% confidence interval = 79.2 (72.1, 86.2)]; this difference remained significant even after controlling for potential confounders. Similar difference was also found in SNP% and SNPmax between POAG and controls (p < 0.001). Age and diastolic blood pressure were inversely correlated with microvascular endothelial function.Conclusion:There was an impairment of microvascular endothelial function and endothelial-independent vasodilatation in POAG patients. Microvascular endothelial function is a potential risk factor for POAG.

Spatial correlation between localized decreases in exploratory visual search performance and areas of glaucomatous visual field loss.

Visual search is a critical skill for several daily tasks and may be compromised in patients with impaired vision. The objective of this study was to study the relationships between exploratory visual search performance (EVSP) visual field (VF) sensitivity in patients with glaucoma. Primary open-angle glaucoma patients (POAG; n = 29) and healthy (Control; n = 28) individuals with best corrected visual acuity better than 0.2 logMAR underwent a comprehensive ophthalmological examination, including Humphrey VF tests (24-2 SITA-Standard), and a monocular exploratory visual search digit-based task performed using a software that quantifies the time spent to find a targert on a random array of digits distributed on nine sequential screens. The screens were divided into five areas to topographically match with five VF sectors. As expected, POAG eyes had worse VF mean deviation (MD) sensitivity and EVSP than Controls (MD - 8.02 ± 7.88dB vs - 1.43 ± 1.50dB, p < 0.0001; and total EVSP time 106.42 ± 59.64s vs 52.75 ± 19.07s, p < 0.0001). MD sensitivity of both groups significantly correlated with total EVSP time (POAG r = - 0.45, p = 0.01; and Control r = 0.37, p = 0.049). A significant relationship was observed between EVSP (individual time) and both visual acuity (p = 0.006) and glaucoma diagnosis (p = 0.005). The mean sensitivity of the peripheral VF areas of the POAG group showed significant correlation with the individual search time in the corresponding spatial areas, except in the peripheral superior temporal area (r = - 0.35, p = 0.06). These data indicate that POAG patients' EVSP is impaired in topographically-correspondent VF areas with sensitivity loss. Visual search may be considered as a measure of impairment of daily activities in glaucoma patients, if further similar tests using binocular conditions corroborate our findings.

Comparative Costs Analysis of POAG Patients after SLT and Receiving Only Medical Treatment

Selective laser trabeculoplasty is a widely spread method of primary open-angle glaucoma treatment. Confirmation of SLT treatment efficacy is associated with economic feasibility and is used for reducing costs for patients.The purposeof this study was comparative analysis of the cost value for patients with POAG, following SLT and having medical treatment without surgery, as well as determining the dynamics of the cost of treatment for patients at all its stages. An analysis of 250 medical charts of POAG patients, who underwent SLT (treatment group) and 50 medical charts of patients with POAG, who were treated conservatively (control group) was carried out, IOP before the surgery was from 20 to 30mm Hg. Selective laser trabeculoplasty was performed using Quantel Medical Optimis with Solutis device according to the standard technology. During the whole treatment course IOP every patient was examined 5 times: 1 day after SLT, 1 month, 3 months, 6 months and 1 year after the surgery (treatment group patients) and at primary visit, 1 month, 3 months, 6 months and 1 year later (patients of the control group). Linear method and cluster analysis were used as mathematical methods; data processing was performed using software STATISTICA 10. The obtained results allow to compare the costs for patients received SLT and treated without surgery, as well as the dynamics of the patient costs at every stage of the treatment, that can be concerned for the further clinical and economical correction of the whole treatment course for POAG patients.