Primary Angle-closure Glaucoma Group Research Articles

Association Between Serum Lipid Levels and Patients With Primary Angle-Closure Glaucoma in China: A Cross Sectional, Case–Control Study

Objective: To evaluate the serum lipid levels of patients with primary angle-closure glaucoma (PACG) and to investigate the relationship between serum lipid levels and PACG.Methods: In this cross-sectional, case–control study, a total of 320 PACG subjects and 242 age- and sex-matched control subjects were recruited. Serum high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), small dense LDL-C (SDLDL-C), triglyceride (TRIG), and cholesterol (CHOL) levels were measured using enzymatic colorimetry. Serum apolipoprotein A (APOA), apolipoprotein B (APOB), apolipoprotein E (APOE), and lipoprotein(a) (LPa) levels were measured by immunoturbidimetry.Results: The serum LDL-C, TRIG, HDL-C, APOE, LPa, CHOL, APOB, and APOA levels were significantly higher (p < 0.05) in the PACG group than in the control group. Multiple liner regression analyses revealed that there was a statistically correlation between HDL-C levels and mean deviation MD (B = 0.389, P = 0.002, 95% confidence interval [CI] = −1.249 to −0.624); LDL-C levels and MD (B = 0.190, P = 0.019, 95% CI = −5.632 to −1.306); and CHOL levels and MD (B = 0.364, P = 0.27, 95% CI = −7.727 to −1.839). Logistic regression analyses showed that high serum HDL-C (odds ratio [OR] = 11.01, 95% CI = 5.616–21.587), LDL-C (OR = 1.330, 95% CI = 1.079–1.640), SDLDL-C (OR = 1.007, 95% CI = 1.005–1.008), APOA (OR = 13.621, 95% CI = 7.251–25.591), APOB (OR = 2.243, 95% CI = 1.060–4.732), LPa (OR = 0.999, 95% CI = 0.998–1.00), and CHOL (OR = 1.131, 95% CI = 1.005–1.326) levels were significantly associated with PACG.Conclusions: High serum HDL-C, LDL-C, APOA, APOB, LPa, and CHOL levels were associated with PACG.

Comparative Study of Lamina Cribrosa Thickness Between Primary Angle-Closure and Primary Open-Angle Glaucoma.

PurposeTo compare lamina cribrosa thickness (LCT) of primary angle-closure glaucoma (PACG) and primary open-angle glaucoma (POAG) using the enhanced depth-imaging mode of the Heidelberg Spectralis spectral-domain optical coherence tomography (EDI-OCT).Patients and MethodsA comparative cross-sectional study was conducted. We enrolled 34 patients with PACG, 38 with POAG, and 62 controls, testing only one eye of each participant. Lamina cribrosa thickness was determined at the center of the optic nerve head using EDI-OCT. Nine points of LCT were measured, and LCT averages were analyzed.ResultsMean age, number of glaucoma medications, current intraocular pressure (IOP), cup to disc ratio, and visual field indices, were not significantly different between PACG and POAG eyes. The maximum IOP (SD) was higher in PACG than in POAG, at 32.5 (10.46) vs 25.05 (6.42) mmHg (p = 0.001), and LCTs were significantly different among the PACG, POAG and control groups. Mean (SD) LCTs were 226.99 (31.08), 257.17 (19.46), and 290.75 (28.02) μm, respectively (p < 0.001). Lamina cribrosa thickness was correlated with mean deviation of the visual field (p = 0.001; correlation coefficient, rs = 0.347), while it was inversely correlated with maximum IOP (p < 0.001; correlation coefficient, rs = −0.592). Linear regression analysis revealed that LCT was inversely related to age (p = 0.008), female (p = 0.018), and maximum IOP (p = 0.002). LCT was marginally related to visual field MD (p = 0.053).ConclusionGlaucomatous eyes had thinner LCT than controls, and maximum IOP was inversely correlated to the LCT. PACG eyes had higher maximum IOP and thinner LCT than POAG ones. In living eye, EDI-OCT emphasizes the pressure-dependent mechanism of glaucoma on lamina cribrosa deformation and the higher IOP-loaded stress which leads to a greater lamina cribrosa strain.

Systemic inflammation in both open-angle and angle-closure glaucoma: role of platelet-to-lymphocyte ratio.

To analyse the effect of systemic inflammatory status in patients with primary open-angle glaucoma (POAG) and primary angle-closure glaucoma (PACG) by calculating platelet-to-lymphocyte ratio (PLR) and neutrophil-to-lymphocyte ratio (NLR). This retrospective case-control study included 200 patients with POAG, 22 patients with PACG and 100 healthy subjects. The participants' white-blood-cell, lymphocyte, neutrophil, and platelet counts were recorded from previous blood assays. NLR and PLR were calculated manually. Results were compared among the groups. Both the POAG and PACG groups had higher platelet counts and PLR values than the control group (p=0.001 and p=0.001; respectively). The difference in NLR between POAG, PACG and control groups was not statistically significant (p=0.076). The POAG group had higher NLR values than the control (p=0.035). Both the POAG and the PACG groups exhibited higher platelet and PLR levels than the control. These results indicate a potential role of systemic inflammation in the pathogenesis of POAG and PACG (Tab. 4, Fig. 1, Ref. 35).

Optic disc morphology in primary open-angle glaucoma versus primary angle-closure glaucoma in South India.

Purpose:The aim of this study was to investigate the optic disc morphology in primary angle-closure glaucoma (PACG) versus primary open-angle glaucoma (POAG) in South Indians.Methods:A total of 60 patients (60 eyes) with PACG and 52 patients (52 eyes) with POAG were included in a cross-sectional observational study. The glaucoma diagnosis was based on a glaucomatous appearance of the optic disc correlating with visual field defects. The glaucoma was graded as early, moderate, or severe, depending upon perimetric loss. All patients underwent an ophthalmic evaluation, including visual field examination and planimetric analysis of 30° stereoscopic color optic disc photographs.Results:The POAG and PACG groups did not differ significantly in a disc or rim area, rim width, and frequencies of disc hemorrhages or rim notches. However, early POAG group (n = 15) had a significantly deeper cup depth (P = 0.01), larger beta zone (P = 0.01), and a higher frequency of localized retinal nerve fiber layer (RNFL) defects (P = 0.02) than early PACG (n = 20).Conclusion:In the early stage of the disease, POAG compared to PACG may be characterized by deeper disc cupping, a larger beta zone of peripapillary atrophy, and a higher frequency of localized RNFL defects. Such differences in early glaucoma may suggest differences in pathophysiology in POAG and PACG.

Diffusion tensor imaging of the visual pathway in dogs with primary angle-closure glaucoma.

To describe measurements of in vivo structures of the visual pathway beyond the retina and optic nerve head associated with canine primary angle-closure glaucoma (PACG). A prospective pilot study was conducted using magnetic resonance diffusion tensor imaging (DTI) to obtain quantitative measures of the optic nerve, chiasm, tract, and lateral geniculate nucleus (LGN) in dogs with and without PACG. 3-Tesla DTI was performed on six affected dogs and five breed, age- and sex-matched controls. DTI indices of the optic nerve, optic chiasm, optic tracts, and LGN were compared between normal, unilateral PACG, and bilateral PACG groups. Intra-class correlation coefficient (ICC) was calculated to assess intra-observer reliability. Quantitative measurements of the optic nerve, optic tract, optic chiasm, and LGN were obtained in all dogs. There was a trend for reduced fractional anisotropy (FA) associated with disease for all structures assessed. Compared to the same structure in normal dogs, FA, and radial diffusivity (RD) of the optic nerve was consistently higher in the unaffected eye in dogs with unilateral PACG. Intra-observer reliability was excellent for measurements of the optic nerve (ICC: 0.92), good for measurements of the optic tract (ICC: 0.89) and acceptable for measures of the optic chiasm (ICC: 0.71) and lateral geniculate nuclei (ICC: 0.76). Diffusivity and anisotropy measures provide a quantifiable means to evaluate the visual pathway in dogs. DTI has potential to provide in vivo measures of axonal and myelin injury and transsynaptic degeneration in canine PACG.

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

Purpose To investigate the serum changes of oxidative stress markers and the relationship between these factors and visual field (VF) progression in patients with primary angle closure glaucoma (PACG). Methods A case-control and a prospective cohort study. A total of 94 patients with PACG and 89 normal controls were enrolled. Furthermore, 94 PACG subjects were followed up for at least two years (once every six months). All participants were evaluated for serum levels of superoxide dismutase (SOD), total antioxidant status (TAS), hydrogen peroxide (H2O2), malondialdehyde (MDA), glutathione peroxidase, glutathione reductase, and detailed eye and systematic examination. Binary logistic regression analysis and Cox regression analysis were performed. Results The serum levels of SOD and TAS in the PACG group were significantly lower than those in the control group (p < 0.001). Meanwhile, PACG subjects had significantly higher levels of MDA and H2O2 than the normal control subjects (p < 0.001). Serum levels of TAS (OR = 0.773, 95%CI = 0.349 − 0.714, p < 0.001), SOD (OR = 0.975, 95%CI = 0.955 − 0.995, p < 0.001), MDA (OR = 1.155, 95%CI = 1.080 − 1.235, p < 0.001), and H2O2 (OR = 1.216, 95%CI = 1.142 − 1.295, p < 0.001) were independent risk/protective factors for PACG. TAS levels (HR = 0.041, 95%CI = 0.008–0.218, p < 0.001), SOD levels (HR = 0.983, 95%CI = 0.971–0.994, p = 0.003), and MDA levels (HR = 1.010, 95%CI = 1.001–1.018, p = 0.015) at baseline were associated with visual field progression. Kaplan–Meier curves reveal that patients with TAS < 0.95/SOD < 143/MDA > 12 had a significantly higher percentage of PACG progression (p < 0.05). Conclusions Decreased levels of TAS and SOD as well as increased levels of MDA at baseline were associated with VF progression in patients with PACG. These findings suggest that oxidative stress was involved in the onset and development of PACG.

Plateau Iris and Severity of Primary Angle Closure Glaucoma

To compare the distribution of plateau iris in eyes across varying severity of primary angle closure glaucoma (PACG) using standardized ultrasound biomicroscopy (UBM) criteria. Cross-sectional study. UBM was performed on 210 patients with PACG who had previously undergone laser peripheral iridotomy. Plateau iris was defined as the presence of all the following UBM criteria in ≥2 quadrants of the angle: anteriorly directed ciliary body, absent ciliary sulcus, iris angulation, flat iris plane, and iridotrabecular contact. Disease severity was based on the visual field mean deviation (MD) and classified as early-to-moderate (MD ≥-12 dB), advanced (-12.01 dB to-20 dB), and severe (MD <-20 dB). Of 210 subjects recruited, 23 were excluded because of poor quality UBM images. The remaining 187 patients were categorized as having early-to-moderate (n= 103), advanced (n= 38), and severe PACG (n= 46). Of these subjects, 48.1% were male, and 90.9% were of Chinese ethnicity. The overall proportion of plateau iris was 36.9%, with 32.0% (33/103) in early-to-moderate, 34.2% (13/38) in advanced, and 50% (23/46) in severe PACG (P= .03, comparing severe PACG with early-to-moderate groups). Among the severe PACG group, those with plateau iris configuration had significantly smaller anterior chamber area (P= .03) and volume (P= .01) compared with those without plateau iris. The higher proportion of plateau iris configuration in eyes with severe PACG compared with early-to-moderate PACG suggest that this may be a contributory factor for disease severity.

Altered spontaneous neuronal activity and functional connectivity pattern in primary angle-closure glaucoma: a resting-state fMRI study.

To explore the alterations of spontaneous neuronal activity and functional connectivity pattern using fractional amplitude of low-frequency fluctuation (fALFF) and functional connectivity (FC) in patients with primary angle-closure glaucoma (PACG) and fALFF relationship with the glaucoma clinical indices. Forty-two PACG patients and 21 normal controls were enrolled in this study. Resting-state functional magnetic resonance imaging was firstly analyzed by fALFF and brain regions with altered fALFF between groups were selected as seeds for the further FC analysis. The relationships between fALFF/FC values of abnormal regions and ophthalmological measures, including mean deviation of visual field (MDVF) and retinal nerve fiber layer (RNFL) thickness, were also analyzed. Compared with NC, PACG had significant lower fALFF values in the left cuneus, left middle temporal gyrus, right middle temporal gyrus, and right precentral gyrus, while higher fALFF values in the bilateral superior frontal gyrus (P < 0.05 after correction). Furthermore, PACG showed increased FC between left cuneus and bilateral superior frontal gyrus/bilateral posterior cingulate gyrus; between left middle temporal gyrus and bilateral superior frontal gyrus; and between right middle temporal gyrus and bilateral insular (P < 0.05 after correction). In addition, in the PACG group, the mean fALFF values of the left cuneus were positively correlated with MDVF (R = 0.419, P = 0.005) and RNFL thickness (R = 0.322, P = 0.038). Meanwhile, the mean fALFF values of bilateral superior frontal gyrus were negatively correlated with MDVF (R = - 0.454, P = 0.003) and RNFL thickness (R = - 0.556, P < 0.001). PACG exhibited abnormal spontaneous neural activity and connectivity in several brain regions mainly associated with visual and visual-related functions. In addition, the fALFF values of the left cuneus and bilateral superior frontal gyrus may be complementary biomarkers for assessing the disease severity.

Retrospective case-control data of serum nitrotyrosine level and clinical biomedical indices in primary glaucoma patients.

From April to December 2017, the case-control data were collected in the Department of Ophthalmology & Visual Science, Eye & ENT Hospital, Fudan University. One hundred primary angle closure glaucoma (PACG), one hundred primary open angle glaucoma (POAG) patients and two hundred control participants were consecutively recruited. The serum nitrotyrosine (NT) levels was not significant different in PACG or POAG patients stratified by gender (1,868.17±427.13 nmol/L vs. 1,768.77±410.17 nmol/L, p>0.05; 1,734.04±460.74 vs. 1,696.46±405.73 nmol/L, p>0.05). Serum NT level was not significantly associated with glaucoma severity in either PACG group or POAG group based on mean deviation (MD) (mild, n=30; moderate, n=24; sever, n=19; blinding, n=27, p>0.05, in Table 3 for PACG; mild, n=9; moderate, n=20; sever, n=21; blinding, n=40; p>0.05, in Table 4 for POAG). Multivariable logistic regression analysis indicated that the risk of developing PACG were significantly associated with serum total triglyceride (TG) and uric acid (UA) levels (OR=1.638, 95%CI: 1.059-2.531, p=0.026 for TG, OR=0.003, 95%CI: 0-0.461, p=0.024 for UA). Serum TG, gamma-glutamyl transferase (GGT) and total bilirubin (TB) levels were significantly associated with POAG (OR=2.00, 95%CI: 1.363-2.934, p<0.001 for TG; OR=0.972, 95%CI: 0.949-0.996, p=0.022 for GGT; OR=1.115, 95%CI: 1.042-1.194, p=0.002 for TB). Descriptions of the data are also available in our recent paper published in Nitric Oxide, “Peroxynitrite is a novel risk factor and treatment target of glaucoma” [1].

Glaucomatous Progression After Lens Extraction in Primary Angle Closure Disease Spectrum.

Substantial proportion of primary angle closure glaucoma (PACG) eyes showed glaucomatous worsening after successful lens extraction and intraocular pressure (IOP) control, which may suggest that an earlier intervention may be required to prevent PACG. The purpose of this study was to investigate the longitudinal clinical course of the primary angle closure (PAC) disease spectrum, including PAC, primary angle closure suspect (PACS), and PACG patients, who underwent lens extraction. This retrospective observational study included 77 eyes from patients with PACS, PAC, and PACG who underwent lens extraction and were followed up for >2 years after surgery. The mean, peak, and fluctuation of IOP were analyzed before and after lens extraction among groups. Visual field (VF) mean deviation was compared immediately after lens extraction and the final follow-up. Postoperative glaucoma progression determined by 3 criteria (optic disc/retinal nerve fiber layer photographs, optical coherent tomography, and VF) was compared among the 3 groups. Seventeen PACS, 24 PAC, and 36 PACG eyes were included. The mean and peak IOP, and IOP fluctuation IOP were significantly reduced postoperatively in all groups. Postoperative VF mean deviation was significantly aggravated only in the PACG group (from -7.26 to -8.82 dB, P<0.001). The prevalence of postoperative glaucoma progression by at least 1 criterion was significantly higher in PACG, and none of the eyes with PACS and PAC showed VF conversion (PACS, PAC, PACG; 11.8%, 12.5% vs. 61.1% in disc/retinal nerve fiber layer, 11.8%, 8.3% vs. 63.9% in optical coherent tomography, 0%, 0% vs. 33.3% in VF, all P<0.001). In the PAC spectrum, lens extraction achieved significant IOP reduction. However, despite IOP control, a substantial proportion of PACG eyes showed glaucomatous progression. This result may suggest that lens extraction should be performed early to prevent PACG.

Evaluation of spontaneous retinal venous pulsation in primary open-angle and primary angle-closure glaucoma patients

Introduction: Spontaneous retinal venous pulsation (SRVP) is a rhythmic variation in the calibre of one or more retinal veins. The incidence of SRVP was reduced in glaucoma patients. It was also reduced in people with raised intracranial pressure compared to a healthy population.&#x0D; Purpose: The main objective was to report the frequency and rate of SRVP in primary open-angle glaucoma (POAG) and primary angle-closure glaucoma (PACG) patients and to associate these with the severity of glaucoma in Malay patients.&#x0D; Design of study: A comparative cross-sectional study.&#x0D; Materials and methods: A comparative cross-sectional study involving primary glaucoma patients attending the eye clinic at Hospital Universiti Sains Malaysia (HUSM), Kelantan, Malaysia, was performed between December 2015 and June 2017. The main outcomes measured were the presence and rate of SRVP using a confocalscanning laser ophthalmoscope (Spectralis High-Resolution Optical Coherence Tomography Angiography, Heidelberg Engineering GmbH, Heidelberg, Germany). In the presence of SRVP, the rate of SRVP in one minute was counted manually based on the real-time fundus movie recorded using the confocal scanning laser ophthalmoscope.&#x0D; Results: Thirty-eight POAG, 14 PACG, and 51 control group subjects were included. There was a significantly lower incidence of SRVP in primary glaucoma patients than in the control group (p = 0.003). The presence of SRVP was significantly lower in POAG than PACG (p = 0.04). There was no significant difference in the rate ofSRVP between primary glaucoma patients and the control group (p = 0.873) or between the POAG group and PACG group (p = 0.511). There was no association of incidence (p = 0.574) and rate (p = 0.167) of SRVP according to the severity of glaucoma. Systolic blood pressure (95% CI: 0.95–1.00, p = 0.038) and retinal nervefibre layer thickness (95% CI: 1.01–1.09, p = 0.008) showed a significant association with the presence of SRVP.&#x0D; Conclusions: SRVP is a potential predictive factor for detection of primary glaucoma. The role of SRVP in the severity of glaucoma is still unclear. The role of SRVP in PACG patients warrants further studies in the future.

Relationship between nailfold capillary morphology and retinal thickness and retinal vessel density in primary open-angle and angle-closure glaucoma.

To compare the morphological characteristics of the nailfold capillaries in glaucoma patients with those in healthy subjects. To evaluate the relationship of nailfold capillary morphology with retinal thickness and retinal vessel density in patients with primary open-angle (POAG) and primary angle-closure glaucoma (PACG). Fifty-one patients with normal-tension glaucoma, thirty-two patients with hypertension glaucoma, thirty-two PACG patients and sixty-one healthy subjects were included in this cross-sectional study. Patients with connective tissue diseases or taking anticoagulation or antiplatelet agents were excluded. Nailfold capillaroscopy, spectral-domain optical coherence tomography and optical coherence tomography angiography were used to evaluate the nailfold capillary morphology, retinal thickness and retinal vessel density, respectively. Nailfold capillary morphological features, including lower capillary density, greater tortuosity, more dilated capillaries >50μm and more avascular zones >100μm, were more common in POAG and PACG patients than in control subjects (all p<0.001). In the POAG group, nailfold vessel density was negatively correlated with ganglion cell complex (GCC) thickness (odds ratio [OR]=0.908, p=0.010) and radial peripapillary capillary (RPC) density (OR=0.787, p=0.025). Tortuosity degree was negatively associated with RPC density (OR=0.804, p=0.016). In the PACG group, no evident relationship between nailfold capillary morphology and retinal thickness or retinal vessel density was detected (all p>0.05). Nailfold capillary bed abnormalities were observed in both POAG and PACG patients. The nailfold capillary features, especially microvascular density and tortuosity degree, had a significant association with GCC thickness and RPC density in subjects with POAG but not in those with PACG.

Effect of postural changes on intraocular pressure in patients with acute angle-closure glaucoma in Indian population

Objective: The objective of the study was to compare the posture-induced intraocular pressure (IOP) changes in primary angle-closure glaucoma (PACG) with or without glaucoma medications, and healthy control eyes with normal IOPs in Indian subjects. Materials and Methods: The IOP was measured in the sitting position and the supine position after 10, 20, and 30 min with a rebound tonometer. Results: Twenty-five patients with PACG and 30 controls with normal IOPs were studied. The IOP in the sitting position measured with the rebound tonometer was 13.8 + 3.2 mm Hg in eyes with PAC, and 12.9 + 2.9 mm Hg in eyes with normal IOPs. The IOP increased to 14.4 mm Hg, 16.8 mm Hg, and 18.9 mm Hg at 10 min, 20 min, and 30 min in PACG subjects. In normal age-matched controls, the IOP increased to 13.4 mm Hg, 14.9 mm Hg, and 17.8 mm Hg at 10 min, 20 min, and 30 min, respectively, but none of these differences were significant (P = 0.09; P = 0.08, P = 0.08). The mean postural IOP change from baseline was also not significant between the two groups. Only three patients were on single antiglaucoma medication with well-controlled IOP in the PACG group. Conclusions: Postural IOP changes are comparable among eyes with PACG with and without glaucoma medications, and control eyes.

Long Term Intraocular Pressure Change after Phacoemulsification with Intraocular Lens Implantation in Glaucomatous and Non-glaucomatous Patients, Panyananthaphikkhu Chonprathan Medical Center

OBJECTIVES: To evaluate long term intraocular pressure (IOP) following phacoemulsification with intraocular lens implantation in glaucoma and normal patients. MATERIAL AND METHODS: A retrospective analysis of 208 patients who had undergone phacoemulsification by the same surgeon at Panyananthaphikkhu Chonprathan Medical Center between February 2011 and February 2015. The patients were divided into 3 groups: no glaucoma (NG), primary open-angle glaucoma (POAG) and primary angle-closure glaucoma (PACG). Preoperative and postoperative best-corrected visual acuity (VA), IOP, and the number of glaucoma medications were recorded. IOP was evaluated before surgery and post-surgery for 1 month, 3 months, and last follow-up (mean 40 months). Repeated measure ANOVA and Post hoc by Scheffe test was used to compare IOP between 3 groups over time. Paired t-test was conducted to determine the relationship between preoperative IOP and postoperative IOP. The p-value of less than 0.05 was set for statistically significant. RESULT: There were 86 patients in the NG group, 61 patients in the POAG group, and 61 patients in the PACG group. The first month saw the mean IOP significantly decrease in all groups (p < 0.001): NG group decreased 2.06 ± 2.21mmHg, POAG group 2.97 ± 3.25 mmHg, and PACG group 3.18 ± 2.77 mmHg. At 3 months the mean IOP was significantly decrease in all group(p < 0.001):NG group decreased 2.44 ± 2.14 mmHg, POAG group 2.72 ± 2.73 mmHg, and PACG group 3.51 ± 2.78 mmHg. At the final follow-up visit the mean IOP still significantly decrease in all group (p < 0.001): NG group decreased 1.45 ± 1.96 mmHg, POAG group 2.17 ± 2.98 mmHg, and PACG group 3.32 ± 2.84 mmHg. Eye with higher preoperative IOP has the greatest IOP- lowering effect. The number of glaucoma medication slightly decreased even though they are both the groups of open and closed angle (p = 0.002 VS p < 0.001). Visual acuity was significantly improved after phacoemulsification in all group. CONCLUSION: Phacoemulsification not only improves the visual acuity but also provides a long term significant decrease in IOP and glaucoma medication. This IOP-lowering effect is proportional to preoperative IOP.

Frequency-specific oscillations synchronization in primary angle-closure glaucoma.

Background Previous neuroimaging studies demonstrated that patients with primary angle-closure glaucoma were accompanied by abnormal neuronal activity. Purpose To investigate frequency-dependent local oscillations synchronization in primary angle-closure glaucoma using the regional homogeneity method. Material and Methods In total, 37 individuals with primary angle-closure glaucoma (20 men, 17 women) and 37 normal-sighted controls (20 men, 17 women) closely matched in age, sex, and education underwent resting-state MRI scans. We compared the different regional homogeneity values in full band (0.01–0.08 Hz) and two different frequency bands (slow-4: 0.027–0.073 Hz and slow-5: 0.010–0.027 Hz) between two groups. Results Compared to the normal-sighted group, the primary angle-closure glaucoma group showed decreased regional homogeneity values in the left calcarine and left postcentral in full band. The primary angle-closure glaucoma group showed increased regional homogeneity values in the bilateral superior medial frontal lobe in the slow-4 band. The primary angle-closure glaucoma group exhibited decreased regional homogeneity values in the right calcarine in the slow-5 band. Specifically, we found that the regional homogeneity values in the right superior frontal lobe were greater in the slow-4 than in the slow-5 band, whereas regional homogeneity in the left calcarine, right pallidum, left inferior occipital gyrus, left superior occipital gyrus, left postcentral/angular gyrus, left paracentral lobule, left superior parietal gyrus, and right precuneus gyrus were greater in the slow-5 than in the slow-4 band. Conclusion Primary angle-closure glaucoma groups showed abnormal regional homogeneity in visual network (calcarine) and default mode network (superior medial frontal lobe) at two frequency bands. Moreover, the regional homogeneity signals in slow-5 band showed closely related to the severity of individuals with primary angle-closure glaucoma.

Associations between the red blood cell distribution width and primary angle-closure glaucoma: a potential for disease prediction.

The red blood cell distribution width (RDW) is a simple and inexpensive laboratory parameter that can be linked to oxidative stress, inflammation and microvascular flow resistance. For this research, we performed a large-sample case-control study to describe the relationships between the RDW and primary angle-closure glaucoma (PACG). A total of 1191 PACG patients (422 males and 769 females), who were divided into mild, moderate and severe PACG groups, and 982 healthy controls (344 males and 638 females) were recruited between January 2008 and June 2018. Detailed eye and physical examinations were performed for each subject. Based on the laboratory results, the mean RDW was significantly higher (p < 0.001) in the PACG group (13.01 ± 0.82%) than in the control group (12.65 ± 0.53%). Moreover, the mean RDW level was lower (p < 0.05) in the mild PACG group than in the moderate and severe PACG groups. The Pearson correlation analyses showed significant positive correlations between the mean deviation and the RDW (r = 0.141, p < 0.001) and the intraocular pressure and the RDW (r = 0.085, p = 0.004). After adjusting for the confounding factors, the logistic regression analyses indicated that the odds ratio for the PACG group was 2.318 (p < 0.001, 95% confidence interval 1.997, 2.690) when compared to the control group. Additionally, an increased RDW was associated with the PACG severity, and this trend was also observed in the gender and age subgroups. In summary, the results of our study showed that an elevated RDW was associated with PACG and its severity. If future studies confirm this relationship, the use of an RDW assessment may help to predict the PACG severity in each patient in order to better customise effective prevention treatments.

Altered functional connectivity density in primary angle-closure glaucoma patients at resting-state.

Primary angle-closure glaucoma (PACG) is a neurodegenerative disease. Previous structural and functional studies of functional magnetic resonance imaging (fMRI) have demonstrated widespread dysfunction of spontaneous activity in the PACG brain. In this study, we applied a data-driven graph theory approach of functional connectivity density (FCD) mapping to investigate the altered local and global functional connectivity (FC) of the cortex in PACG. Forty-five PACG patients (53.28±10.79 years, 17 males/28 females) and 46 well-matched healthy controls (HCs) (52.67±11.01 years,18 males/28 females) received resting-state fMRI scans. All PACG patients finished complete ophthalmologic examinations, including retinal nerve fiber layer thickness (RNFLT), intraocular pressure (IOP), average cup to disc ratio (A-C/D), and vertical cup to disc ratio (V-C/D). We calculated the between-group FCD difference for short-range and long-range in each voxel. Then, we generated the intrinsic FC of the seed region with the whole brain. Finally, correlations were investigated between FCD value of the altered regions and clinical variables. PACG patients showed increased short-range FCD in the left inferior frontal gyrus (IFG)/insula/parahippocampal gyrus and right IFG/insula (P<0.05, corrected), compared with the HCs. Simultaneously, the decreased regions in short-range FCD map were the occipital/cuneus/precuneus/superior parietal/postcentral lobe (P<0.05, corrected). In the PACG groups, decreased long-range FCD was observed in the left middle frontal gyrus compared to the HC (P<0.05, corrected). RNFLT was positively correlated with decreased short-range FCD value of the occipital/cuneus/precuneus/superior parietal/postcentral lobes, and the A-C/D was negatively correlated with the increased short-range FCD value of the left IFG/insula/parahippocampal gyrus, and the right IFG/insula. Our findings suggest that PACG can induce extensive brain dysfunction, and showed different spatial distribution in short- and long-range FCD.

Comparison of medical comorbidity between patients with primary angle-closure glaucoma and a control cohort: a population-based study from Taiwan

ObjectiveTo determine the prevalence and risk of systemic comorbidities in primary angle-closure glaucoma in Taiwan population.MethodsWe included 3322 primary angle-closure glaucoma (PACG) subjects and randomly selected patients without PACG from...

Frequency-dependent neural activity in primary angle-closure glaucoma.

ObjectiveIn this study, we aimed to investigate the frequency-dependent spontaneous neural activity in primary angle-closure glaucoma (PACG) using the amplitude of low-frequency fluctuations (ALFF) method.Patients and methodsIn total, 52 PACG individuals (24 males and 28 females) and 52 normal-sighted controls (NS; 24 males and 28 females) who were closely matched in age, sex, and education underwent resting-state magnetic resonance imaging scans. A repeated-measures ANOVA and post hoc two-sample t-tests were conducted to analyze the different ALFF values in two different frequency bands (slow-4, 0.027–0.073 Hz and slow-5, 0.010–0.027 Hz) between the two groups. Pearson’s correlation analysis was conducted to reveal the relationship between the mean ALFF values and clinical variables in the PACG group.ResultsCompared to the NS group, the PACG group had high ALFF values in the right inferior occipital gyrus and low ALFF values in the left middle occipital gyrus, left precentral gyrus, and left postcentral gyrus in the slow-4 band. The PACG group had high ALFF values in the right inferior occipital gyrus and low ALFF values in the left inferior parietal lobule, left postcentral gyrus, and right precentral/postcentral gyrus in the slow-5 band. Specifically, we found that the abnormal ALFF values in the bilateral posterior cingulate gyrus and bilateral precuneus were higher in the slow-4 than in the slow-5 band, whereas ALFF in the bilateral frontal lobe, right fusiform, and right cerebellum posterior lobe were higher in the slow-5 than in the slow-4 band. The greater mean ALFF values of the right inferior occipital gyrus were associated with smaller retinal nerve fiber layer thickness and greater visual fields in PACG group in the slow-4 band.ConclusionOur results highlighted that individuals in the PACG group showed abnormal spontaneous neural activities in the visual cortices, sensorimotor cortices, frontal lobe, frontoparietal network, and default mode network at two frequency bands, which might indicate impaired vision and cognition and emotion function in PACG individuals. These findings offer important insight into the understanding of the neural mechanism of PACG.

Choroidal Microvascular Dropout in Primary Angle Closure Glaucoma

To determine the prevalence and factors associated with the presence of choroidal microvascular dropout (CMvD) in primary angle-closure glaucoma (PACG) eyes compared to primary open-angle glaucoma (POAG) eyes. Cross-sectional study. Thirty-six POAG eyes (36 patients) and 28 PACG eyes (28 patients) underwent optical coherence tomography angiography (OCTA). Presence of CMvD was evaluated on choroidal OCTA slabs. Visual field (VF) defects in the glaucoma eyes were classified into initial nasal defect (IND), initial parafoveal scotoma (IPFS), and combined nasal and parafoveal defect, and the association between type of VF defect and CMvD was evaluated. CMvD was detected in 21 POAG (58.3%) and 10 PACG (35.7%) eyes (P= .07). CMvD in POAG eyes was associated with pretreatment intraocular pressure (odds ratio [OR]= 0.91/mm Hg higher intraocular pressure, P= .06), VF mean deviation (MD, OR=0.75/dB higher MD, P= .007), retinal nerve fiber layer thickness (OR= 0.92/μm increase in thickness, P= .02), and peripapillary vessel density (OR= 0.80/unit increase in density, P= .01). CMvD in PACG eyes was associated only with VF MD (OR= 0.90/dB higher MD, P= .05). When analyzed in the entire cohort of glaucoma patients (64 eyes), CMvD was significantly associated with POAG (OR > 3.5, P < .05) after accounting for glaucoma severity. CMvD was seen in 6 of 7 eyes with IPFS and 1 of 13 with IND in the POAG group (P < .05) and 1 of 2 eyes with IPFS and 0 of 10 with IND in the PACG group (P < .05). Prevalence of CMvD was significantly lower in PACG compared to POAG. As in POAG, CMvD in PACG was associated with advanced VF damage and with IPFS on VF.