Primary Open-angle Glaucoma Group Research Articles

Overview of Central Corneal Thickness in Patients with Glaucoma: A Single Center Observational Study at Dr. M. Djamil General Hospital, Padang, Indonesia

Background: Central corneal thickness (CCT) is an important risk factor in the diagnosis and management of glaucoma. This study aims to determine the CCT picture of various types of glaucoma at Dr. M. Djamil General Hospital Padang. Methods: This descriptive retrospective study involved data from glaucoma patients at Dr. M. Djamil General Hospital Padang for the period January 2019 - December 2020. CCT data was obtained from medical records and OCT computer data. Descriptive analysis was carried out to see the distribution of CCT in ocular hypertension (OHT), glaucoma suspect (GS), normal tension glaucoma (NTG), primary open-angle glaucoma (POAG), and juvenile open-angle glaucoma (JOAG) groups. Results: A total of 123 glaucoma patients were analyzed. The overall mean CCT was 535.50 ± 43.82 µm. The highest mean CCT was in the OHT group (566.30 ± 32.07 µm) and the lowest in POAG (523.39 ± 39.43 µm). The mean age of patients was 35.19 ± 16.20 years. The POAG group had the highest mean age (52.52 ± 9.54 years), while the JOAG group had the lowest (22.00 ± 5.84 years). Conclusion: There are variations in CCT in various types of glaucoma, with OHT having the highest CCT and POAG the lowest. This data can be a basis for consideration in the diagnosis and management of glaucoma in Indonesia.

MP-3 microperimeter in early primary open angle glaucoma with a new pattern.

To investigate macular microperimetry in patients with early primary open angle glaucoma (POAG) using a new custom-made pattern, and analyze the characteristics of macular sensitivity. This case-control study included 38 patients with POAG, who were divided into pre-perimetric glaucoma (18 eyes of 18 patients), early-stage (20 eyes of 20 patients), and control (20 eyes of 20 patients) groups. All subjects underwent standard 24-2 humphrey visual field test. An MP-3 microperimeter with a new custom-made pattern (28 testing points distributed in four quadrants, covering the central 10° of the retina) was used to evaluate macular sensitivity. Ganglion cell complex (GCC) thicknesses were examined using an RS-3000 Advance OCT system. The features of structure and function were analysed per quadrant. The pre-perimetric glaucoma group had significantly lower inferior hemifield macular sensitivity compared to controls (P<0.05). The early-stage POAG group had significantly lower average, inferior hemifield, inferonasal, and inferotemporal mean sensitivities compared to the pre-perimetric glaucoma group (P<0.05), and lower macular sensitivity in all sectors compared to controls (P<0.05). Regarding GCC thickness, all sectors in the early-stage POAG group became thinner compared to those in controls (P<0.05); whereas all sectors in the early-stage POAG group, except the superonasal quadrant, became thinner compared to those in the pre-perimetric glaucoma group (P<0.05). Macular sensitivity and GCC thickness were significantly associated in each sector. The inferotemporal quadrant had the highest correlation coefficients (0.840). The structure-function relationship for the inferonasal and inferotemporal sectors was stronger compared to the corresponding superior sectors. Microperimetry reveals variations in macular sensitivity in patients with early glaucoma earlier than conventional perimetry, particularly in pre-perimetric glaucoma cases in which it might be undetectable by conventional methods. The new custom-made pattern may improve the accuracy of microperimetry by enhancing point arrangement and reducing fatigue effects. Macular sensitivity measured by MP-3 with this pattern shows statistically significant structural and functional associations with the thicknesses of the GCC.

Evaluation of Visual Cortex Activity using Functional Near-Infrared Spectroscopy (fNIRS) in Primary Open Angle and Primary Angle Closure Glaucoma: A pilot study.

Functional Near Infrared Spectroscopy was used to assess visual cortical activity in patients with primary open angle and primary angle closure glaucoma. There was decreased activity in the visual cortex of glaucoma patients correlating with the severity of glaucoma. To evaluate visual cortex activity using fNIRS (Functional Near Infrared Spectroscopy) in primary open angle glaucoma (POAG) and primary angle closure glaucoma (PACG) compared to healthy controls. A total of 30 POAG, 31 PACG, and 30 healthy aged-matched controls from a single centre were recruited in this cross-sectional observational pilot study with purposive sampling. The POAG and PACG groups were age-matched but were not matched for disease severity at recruitment. All participants underwent fNIRS testing using a multi-channel continuous-wave near infra-red system NIRSport 8×7 device (NIRx Medizintechnik GmbH, Berlin, Germany). The visual cortex activity was evaluated in terms of maximum amplitude of change in oxyhemoglobin (OxyHb) concentration over 10 seconds and a comparison was done between three groups. Both POAG and PACG groups were combined (termed as glaucoma group) to assess relationship of visual cortical activity with disease severity {by visual field defect (mean deviation) and retinal nerve fiber layer (RNFL) thickness}. All participants showed the characteristic response of increased OxyHb and decreased DeoxyHb during stimulus presentation. The maximum amplitude of change in OxyHb concentration over 10 seconds was significantly lower in both POAG and PACG groups compared to control in the right and left middle occipital gyri (P<0.05). There was no significant difference between PACG and POAG. Importantly, there was a negative correlation of the visual cortex activity with the visual field defects (mean deviation) (P<0.05) and a positive correlation with RNFL thickness in the glaucoma group (P<0.05). In glaucoma patients, reduction in visual cortical activity was observed which may be indicative of neuronal degeneration occurring in the occipital cortex. Disease severity in glaucoma appears to be closely correlated with visual cortex activity. fNIRS can serve as a useful neuroimaging modality for assessing the hemodynamic and neurodegenerative changes in glaucoma.

A comparison of deep sclerectomy outcomes in eyes with pseudoexfoliation versus primary open angle glaucoma

PurposeTo compare outcomes of augmented deep sclerectomy surgery (DS) with mitomycin C.(MMC) between pseudoexfoliative glaucoma (PEXG) and primary open angle.glaucoma (POAG) patients.. DesignRetrospective cohort study MethodsRetrospective review of patients undergoing DS surgery at the University Eye Hospital Bonn, Germany, from 04/2021 to 09/2022. We performed a matched-pair analysis.between eyes with PEXG (group 1, n = 45) and eyes with POAG (group 2, n = 45). Results90 eyes of 85 patients were included. Complete and qualified success rates for Groups.1 and 2 at one year were 55.6 % and 86.7 % (p = 0.002) and 91.1 % and 93.3 % (p = 0.78).for ≤21 mmHg, and 55.6 % and 86.7 % (p = 0.002) and 88.9 % and 93.3 % (p = 0.53) for.≤18 mmHg respectively..Mean preoperative IOP decreased from 21.11 mmHg in group 1 and 19.64 mmHg in.group 2 (p = 0.31) to 13.64 mmHg and 11.42 mmHg after surgery, respectively, whilst it.was significantly lower in eyes with POAG (p = 0.01). The number of pressure-lowering.drops was also significantly lower in eyes with POAG after 12 months (PEXG: 0.58;.POAG: 0.18; p = 0.01). Eyes with PEXG had a significantly higher rate of Nd:YAG laser.goniopuncture (PEXG: 64.4 %, POAG: 40 %, p = 0.02)..Postoperative complications occurred in 6 eyes (6.7 %) with no vision-threatening.sequelae in either group.There were no significant differences between complication.rates in the two groups (p = 0.18) ConclusionsDS is a safe and effective procedure for lowering IOP in eyes with both POAG and PEXG, with lower overall IOP levels being achieved in eyes with POAG. Significantly more postoperative laser goniopunctures were needed in eyes with PEXG.

Anterior Segment Changes in Patients With Glaucoma Following Cataract Surgery.

This prospective observational study investigates the impact of cataract surgery on anterior segment parameters innonglaucomatous and primary open-angle glaucoma (POAG) eyes, utilizing anterior segment optical coherence tomography (AS-OCT). The study involved 42 Caucasian patients, divided into a control group and a POAG group. Comprehensive ophthalmic examinations were performed along with AS-OCT imaging and biometry preoperatively, as well as on one day, one week, and one month following cataract surgery. The results showed significant post-operativechanges in anterior chamber depth (ACD) and angle width in both groups, suggesting that cataract surgery may influence the structural parameters associated with glaucoma risk and management. Specifically, a marked increase in ACD and improvement in angle-opening distances were observed, highlighting the potential of cataract extraction to alter intraocular fluid dynamics favorably. Despite these changes, the study noted an initial spike in increased intraocular pressure (IOP) in POAG patients immediately post-operative, which stabilized during follow-up. For the control group, IOP showed gradually reducing IOP values in the follow-up visits. The findings underscore the role of advanced imaging technologies in understanding glaucoma's pathophysiology and the potential benefits of cataract surgery in glaucoma patients. The study advocates for further research with a larger, more diverse patient population and extended follow-up to explore the long-term implications of cataract surgery on glaucoma dynamics, emphasizing the importance ofpersonalized management and treatment strategies particularly for glaucoma patients.

Visual Field and Optical Coherence Tomography Parameters With and Without Positive Family History of Glaucoma.

To evaluate the Retinal Nerve Fiber Layer and Ganglion Cell Complex thickness using Spectral Domain Optical Coherence Tomography with and without positive family history of Primary Open Angle Glaucoma and its relation to visual field. Total 120 eyes with each subjects with positive family history of Primary Open Angle Glaucoma (Group I, n=30) and healthy subjects without positive family history of Primary Open Angle Glaucoma (Group II, n=30) undergone complete ophthalmic evaluation with Retinal Nerve Fiber Layer, Ganglion Cell Complex and VF obtained from Spectral Domain Optical Coherence Tomography RTVue-100 and Humphrey visual field respectively .The measurements were analyzed and compared among two groups using independent-t test by using SPSS version 23.The relationship of Retinal Nerve Fiber Layer with visual field were evaluated with correlation analysis. There were 75 patients included in the study.nasal, temporal RNFL and average Ganglion Cell Complex was significantly lower and thinner in Group I with mean difference of -8.53±2.30 µm (p<0.001), -7.35±3.34 µm (p<0.001), -8.52±3.58µm (p<0.001),-11.87±2.24µm (p<0.001), -5.31±1.95µm (p<0.001) and -8.05±1.52µm (p<0.001) respectively. Correlation plot with Retinal Nerve Fiber Layer thickness as predictor of Mean Deviation and Pattern Standard Deviation indicated statistically significant degree of determination in Group I (r=0.455 and r=0.623, p<0.001 and p<0.001). The Optical Coherence Tomography and visual field Parameters are lower in group I and used as an early predictor, diagnosis, monitoring and management.

Corneal Hysteresis as a Marker for Patients with Secondary Glaucoma

ABSTRACT Purpose To investigate and compare the association of corneal hysteresis (CH) in patients with secondary glaucoma to control patients and patients with primary open-angle glaucoma (POAG). Additionally, to determine the consistency of CH measurements in patients with secondary glaucoma. Methods A total of 84 patients (121 eyes) were prospectively included in this study. Twenty-three patients (46 eyes) were healthy controls, 24 patients (40 eyes) were diagnosed with POAG, and 27 patients (35 eyes) were diagnosed with a form of secondary glaucoma. CH and intraocular pressure (IOP) were measured using the Ocular Response Analyzer. Three measurements per eye were performed and used for the analysis and to determine fluctuations in CH data. One-way ANOVA with post-hoc Bonferroni analysis and Chi-Squared testing was done to determine differences between groups. Results All patients were matched for age. Patients in both POAG and secondary glaucoma groups were matched for age and IOP. All groups had similar sex and racial compositions as well as similar proportions of diabetes, hypertension, and hyperlipidemia. CH was lower (p < .05) in patients with POAG (9.32 ± 1.64) and secondary glaucoma (7.89 ± 3.18) when compared to healthy controls (11.16 ± 1.60). Fluctuations in CH measurements were minimal in all groups. Further analysis of the secondary glaucoma group revealed no differences in CH between different types of secondary glaucoma (p > .05). Conclusion Patients with secondary glaucoma have lower CH when compared to POAG or control groups. The ORA exhibits precision of CH measurements for control, POAG, and secondary glaucoma groups, making it a reliable tool in management of secondary forms of glaucoma.

Intraocular pressure profile following selective laser trabeculoplasty in pigmentary and primary open-angle glaucoma.

To compare the intraocular pressure (IOP) profile and the incidence of IOP spikes following selective laser trabeculoplasty (SLT) between pigmentary glaucoma (PG) and primary open-angle glaucoma (POAG). Retrospective comparative study of 65 PG eyes of 51 patients matched with 65 POAG eyes of 65 patients who received SLT. Matching was done based on age, gender, glaucoma severity, pre-laser IOP, and number of medications. Post-SLT IOP spike was defined as IOP elevation ≥5mmHg, 30-45 min after the laser. In PG and POAG groups, the average age was 62.33 ± 9.18 and 62.58 ± 9.19 years (p = 0.95). The glaucoma severity (p = 0.708), baseline IOP (PG = 21.61 ± 1.34mmHg vs. POAG = 21.13 ± 5.09mmHg, p = 0.943), and number of topical glaucoma medications(PG = 2.34 ± 1.34 vs. POAG = 2.1 ± 1.41, p = 0.342) were comparable. More PG patients were on oral acetazolamide (PG = 26.15% vs. POAG = 1.5%, p < 0.001). Average logMAR visual acuity was significantly higher in the POAG group (0.207 ± 0.3 vs. 0.192 ± 0.37, p = 0.012). Eyes with PG received lower laser energy (POAG = 63.65 ± 22.03 mJ vs. PG = 43.71 ± 25.68 mJ, p < 0.001). IOP spikes were recorded in 5 PG eyes (7.6%) and none in the POAG group (p = 0.058). Failure rates were similar (PG = 50.7% and POAG = 43.1%, p = 0.205). In multivariable analysis, only pre-laser IOP (coefficient = 2.154 [CI: 0.765-3.543], p = 0.003) was a significant predictor of IOP change percentage after 12 months. SLT was comparably effective in both PG and POAG. IOP spikes were observed only in the PG group, though the total laser energy was lower in this group compared with POAG.

Tear metabolomics for the diagnosis of primary open-angle glaucoma

Primary Open-Angle Glaucoma (POAG) is the most prevalent glaucoma type, and the leading cause of irreversible visual impairment and blindness worldwide. Identification of early POAG biomarkers is of enormous value, as there is not an effective treatment for the glaucomatous optic nerve degeneration (OND). In this pilot study, a metabolomic analysis, by using proton (1H) nuclear magnetic resonance (NMR) spectroscopy was conducted in tears, in order to determine the changes of specific metabolites in the initial glaucoma eyes and to discover potential diagnostic biomarkers. A classification model, based on the metabolomic fingerprint in tears was generated as a non-invasive tool to support the preclinical and clinical POAG diagnosis. 1H NMR spectra were acquired from 30 tear samples corresponding to the POAG group (n = 11) and the control group (n = 19). Data were analysed by multivariate statistics (partial least squares-discriminant analysis: PLS-DA) to determine a model capable of differentiating between groups. The whole data set was split into calibration (65%)/validation (35%), to test the performance and the ability for glaucoma discrimination. The calculated PLS-DA model showed an area under the curve (AUC) of 1, as well as a sensitivity of 100% and a specificity of 83.3% to distinguish POAG group versus control group tear data. This model included 11 metabolites, potential biomarkers of the disease. When comparing the study groups, a decrease in the tear concentration of phenylalanine, phenylacetate, leucine, n-acetylated compounds, formic acid, and uridine, was found in the POAG group. Moreover, an increase in the tear concentration of taurine, glycine, urea, glucose, and unsaturated fatty acids was observed in the POAG group. These results highlight the potential of tear metabolomics by 1H NMR spectroscopy as a non-invasive approach to support early POAG diagnosis and in order to prevent visual loss.

A highly sensitive fluorescent probe RN-NA reveals peroxynitrite as a novel biomarker for primary open angle glaucoma.

To directly quantify peroxynitrite (ONOO-) using a highly sensitive fluorescence resonance energy transfer probe RN-NA, investigate the association between ONOO- and primary open angle glaucoma (POAG), and clarify whether RN-NA could be used as a potential tool for POAG diagnosis. Plasma and aqueous humor (AH) samples were collected from POAG patients (n=100, age: 59.70±6.87y) and age-related cataract (ARC) patients (n=100, age: 61.15±4.60y) admitted to our hospital. Next, RN-NA was used to detect ONOO- in plasma and AH samples, and the relationship between ONOO- level and POAG was analyzed using binary logistic regression. Besides, Pearson correlation analysis was applied to characterize the correlation of the levels of ONOO- with the patients' age, intraocular pressure (IOP), and mean deviation of visual field testing. The ONOO- scavenger MnTMPyP was employed to treat the 3-morpholinosyndnomine (SIN-1)-induced ocular hypertension in mice (n=7, 6-8wk). Finally, the IOP and ONOO- in both eyes were measured 30min after the last drug treatment. ONOO- levels of AH and plasma were significantly higher in the POAG group than in the ARC group (P<0.01). Additionally, ONOO- levels were closely correlated with POAG in a binary logistic regression analysis [odds ratio (OR)=1.008, 95% confidence interval (CI): 1.002-1.013, P<0.01 for AH; OR=1.004, 95%CI: 1.002-1.006, P<0.001 for plasma]. Pearson correlation analysis showed that ONOO- levels in AH or plasma were positively associated with visual field defects (R=0.51, P<0.01 for AH; R=0.45, P<0.001 for plasma), and ONOO- levels in plasma and AH were correlated in the POAG group (R=0.69, P<0.001). However, administering MnTMPyP to mouse eyes reversed the elevated IOP caused by SIN-1 (P<0.05). ONOO- levels in AH and plasma, detected by RN-NA, are significantly related to POAG and positively correlated with visual field defects in POAG patients. Hence, ONOO- is a potential biomarker of POAG, especially advanced POAG. Besides, anti-nitration compounds may be novel ocular hypotensive agents based on the animal study.

Comparison of Schlemm's Canal Morphology Parameters Between Propensity Score-Matched Primary Open-Angle Glaucoma and Exfoliation Glaucoma.

This study aimed to histologically compare the status of Schlemm's canal (SC) and Schlemm's canal endothelial (SCE) cells between trabeculectomy specimens from patients with primary open-angle glaucoma (POAG) and exfoliation glaucoma (EXG). A total of 182 eyes from 152 patients with POAG and 138 eyes from 116 patients with EXG underwent immunohistochemical staining for thrombomodulin. Equal numbers of cases were selected from both groups using propensity score matching. The following parameters were evaluated: total SC length, staining positive and negative SC length (PSC and NSC, respectively), opened and closed SC length, staining positive and opened SC length, staining positive and closed SC length, staining negative and opened SC length (NOSC), and staining negative and closed SC length. After matching for age and gender, 87 cases were selected in each group. The EXG group had significantly higher preoperative IOP and medication scores. PSC was significantly longer in the POAG group, while NSC and NOSC were longer in the EXG group. Multiple regression analysis of these 174 cases revealed that PSC was significantly shorter in the EXG group. After matching for age, gender, preoperative IOP, and medication score, 64 cases were selected in each group, and NOSC was significantly longer in the EXG group. These findings suggest that in EXG, SCE loss occurs independently of background factors such as aging and medication use. The loss of SCE may have a more critical impact on IOP elevation in EXG compared to POAG.

Is Primary Open-Angle Glaucoma a Vascular Disease? Assessment of the Relationship between Retinal Arteriolar Morphology and Glaucoma Severity Using Adaptive Optics.

Retinal vascular abnormalities may be associated with glaucomatous damage. Adaptive optics (AO) is a new technology that enables the analysis of retinal vasculature at the cellular level in vivo. The purpose of this study was to evaluate retinal arteriolar parameters using the rtx1 adaptive optics fundus camera (AO-FC) in patients with primary open-angle glaucoma (POAG) at different stages and to investigate the relationship between these parameters and changes in spectral-domain optical coherence tomography (SD-OCT) and perimetry. Parameters of the retinal supratemporal and infratemporal arterioles (wall thickness (WT), lumen diameter (LD), total diameter (TD), wall-to-lumen ratio (WLR), and cross-sectional area of the vascular wall (WCSA)) were analysed with the rtx1 in 111 POAG eyes, which were divided into three groups according to the severity of the disease, and 70 healthy eyes. The associations between RTX1 values and the cup-to-disk ratio, SD-OCT parameters, and visual field parameters were assessed. Compared with the control group, the POAG groups showed significantly smaller TD and LD values (p < 0.05) and significantly higher WLR and WT values (p < 0.05) for the supratemporal and infratemporal arterioles. TD was significantly positively correlated with the retinal nerve fibre layer (RNFL) and ganglion cell complex (GCC) (p < 0.05). LD was significantly positively correlated with the RNFL, GCC, and rim area (p < 0.05). The WLR was significantly negatively correlated with the RNFL, GCC, rim area, and MD (p < 0.05), while it was significantly positively correlated with the cup-to-disc ratio and PSD (p < 0.05). The results suggest that vascular dysfunction is present in POAG, even at a very early stage of glaucoma, and increases with the severity of the disease.

Association of Primary Open-Angle Glaucoma with Diabetic Retinopathy among Patients with Type 1 and Type 2 Diabetes: A Large Global Database Study

PurposeTo assess the correlation between primary open-angle glaucoma (POAG) and the risk of developing diabetic retinopathy (DR) in patients with type 1 and type 2 diabetes mellitus (DM). DesignA retrospective cohort study leveraging the global patient database of TriNetX Research Network. SubjectsThe study included 44,359 DM patients with POAG and 4,393,300 DM patients without any glaucoma ≥18 years of age. Propensity score matching harmonized the cohorts to 39,680 patients each covering diagnoses from January 1, 2005, to January 1, 2023. MethodsWe analyzed data using specific ICD-10 codes for DM and glaucoma. We matched the cohorts using propensity score matching, adjusting for age, sex, race/ethnicity, blood markers, relevant medical history, and ophthalmic service utilization. Main Outcome MeasuresThe primary outcome was the first-time occurrence of DR, including non-proliferative DR (NPDR), and proliferative DR (PDR), in DM patients with and without glaucoma at 1, 5, and 10-year intervals from their individual index dates. ResultsAt 10 years, T1DM patients with POAG exhibited a heightened risk for any DR (adjusted risk ratios (RR): 4.12; 95% CI: 3.05-5.57, p<0.0001) and PDR (RR: 7.02; 95% CI: 3.62- 13.61, p<0.0001). T2DM patients with POAG also faced an increased 10-year risk for any DR (RR: 2.47; 95% CI: 2.28- 2.68, p<0.0001) and PDR (RR: 3.82; 95% CI: 3.09- 4.70, p<0.0001). The combined association of POAG on DR risk in T1DM and T2DM at 10 years was found to be significantly higher among POAG patients (5.45%) compared to those without glaucoma (2.12%) (adjusted hazard ratios (aHR): 2.33; 95% CI: 2.14-2.53). The cumulative incidence of DR was significantly higher in the POAG group compared to non-glaucoma counterparts after a decade (log-rank p < 0.001). ConclusionsOur findings underscore a substantial association between POAG and DR development in both T1DM and T2DM patients, emphasizing the need for vigilant screening and comprehensive management in glaucomatous patients with DM to mitigate the risk of DR. Future research should delve into elucidating the causal mechanisms driving these observed associations.

Changes in Optic Nerve Head Blood Flow During Horizontal Ocular Duction.

In this study, we aimed to compare blood flow changes in the optic nerve head (ONH) during horizontal ocular duction among normal, primary open-angle glaucoma (POAG), and normal-tension glaucoma (NTG) eyes. In this cross-sectional study, we included 90 eyes from 90 participants (30 control eyes, 30 POAG eyes, and 30 NTG eyes). ONH blood flow was measured with laser speckle flowgraphy using an external fixation light to induce central gaze, abduction, and adduction at 30 degrees for each eye. The mean blur rate (MBR) of the entire ONH area (MA), vascular region (MV), and tissue region (MT), and the change ratio were analyzed. The change ratio was defined as abduction or adduction value/central gaze value. In the control group, MA significantly decreased during adduction (22.9 ± 3.7) compared with that during central gaze (23.6 ± 3.9, P < 0.05). In the POAG group, MA (adduction = 17.4 ± 3.8 and abduction = 17.3 ± 3.6) and MV (adduction = 37.9 ± 5.6 and abduction = 38.0 ± 5.6) significantly decreased during adduction and abduction compared with those during central gaze (18.0 ± 4.1 and 39.5 ± 6.3, respectively, P < 0.05). In the NTG group, MA significantly decreased during adduction (17.4 ± 4.2) compared with that during central gaze (18.1 ± 4.6) and abduction (18.1 ± 4.8, P < 0.05). The change ratio did not differ between the glaucoma and control groups. ONH blood flow decreased during horizontal ocular duction regardless of normal or glaucoma states; however, the change ratio was comparable between the normal and glaucoma groups.

Changes in the morphofunctional parameters of the eye in neovascular glaucoma on the after vitreoretinal surgery

Purpose: to assess morphological and functional parameters of the eyeball in patients with neovascular glaucoma (NVG) and diabetic macular edema (DME) after vitreoretinal interventions.Material and methods. This study involved 60 patients (60 eyes), aged 59 ± 12 including 34 men and 26 women. The patients were divided into three groups: group 1 — 19 patients (19 eyes) with NVG and DME after a vitreoretinal surgery (VRS) for proliferative diabetic retinopathy performed no earlier than a year ago. If DME was found within 6 months after the surgery, a drug was administered intravitreally (3 loading injections given with monthly intervals). The patients’ history contained cataract phacoemulsification with an implantation of an intraocular lens (IOL). Group 2 (23 patients, 23 eyes) consisted of persons with stage III primary open-angle glaucoma (POAG) with the duration of the glaucomatous process of up to 5 years, who received no laser or surgical antiglaucomatous interventions. The history of these patients also contained phacoemulsification operations with IOL implantation. Group 3 (18 patients, 18 eyes), which was composed of patients with pseudophakia but no symptoms of glaucoma or other eye pathology, served as control.Results. The opening of the anterior chamber angle (ACA) in NVG (group 1) was 2.73 times smaller (p = 0.034) than in POAG (Group 2) and 3.69 times smaller than in the control group (p = 0.034). Neovascularization of the iris and the ACA could primarily be seen in patients with NVG (84 %). Goniosynechiae in the ACA of group 1 patients were seen 6.35 times more often than in group 2 patients and 14.45 times more often than in group 3 patients. Rubeosis occurred in group 1 patients 4.65 times as often as in group 2 and 6.64 times more often than in group 3 patients (p = 0.034). Statistically significant differences of morphometric parameters of the optic disc between groups 1 and 2, on the one hand, and group 3, on the other hand were found. Meanwhile, the figures for groups 1 and 2 were statistically comparable, which is explained by the same degree of severity of the glaucomatous process in these groups. The analysis of indices of computer perimetry MD, MS and sLV showed a developed glaucomatous process in groups 1 and 2. The revealed changes are based on pathognomonic factors. In particular, they may be caused by the prior surgical intervention affecting the vitreoretinal interface in group 1 patients.Conclusion. The onset of NVG is primarily caused by a grave course of proliferative diabetic and changes in the ACA profile, due to the formation of synechiae. Regardless of the risk factors, the result of surgical treatment depends on the condition of the ischemic retina and the anterior segment of the eye. Thus, the assessment of the morphofunctional parameters of the eye in patients with NVG and DME after VRS is of great interest. Changes in such parameters as the degree of openness of the ACA, distance from the iris to the IOL, the presence of rubeosis and synechia may be used to determine the methods and tactics of surgery, which will eliminate the pathophysiological factors of the onset and progression of CVH, and reduce postoperative complications.

Cell atlas of trabecular meshwork in glaucomatous non-human primates and DEGs related to tissue contract based on single-cell transcriptomics

As the major channel of aqueous humor outflow, dysfunction of trabecular meshwork (TM) can lead to intraocular pressure elevating, which can trigger primary open-angle glaucoma (POAG). In this study, we use single-cell RNA sequencing (scRNA-seq) technique to build an atlas and further explore the spontaneous POAG and healthy macaques cellular heterogeneity associated with the dysfunction of TM contraction. We built the TM atlas, which identified 14 different cell types. In Beam A, Beam B, Beam C, and smooth muscle cell (SMC) cell types, we first found multiple genes associated with TM contraction (e.g., TPM1, ACTC1, TNNT1), determining their differential expression in the POAG and healthy groups. In addition, the microstructural alterations in TM of POAG non-human primates were observed, which was compact and collapsed. Thus, our study indicated that TPM1 may be a key target for regulating TM structure, contraction function, and resistance of aqueous humor outflow.

Comparison of the Choroid in Primary Open-angle and Angle-Closure Glaucoma Using Optical Coherence Tomography.

The current study highlights distinct choroidal alterations in primary open-angle and angle-closure glaucoma, underscoring the potential of choroidal vascularity index as a valuable indicator for understanding glaucoma pathogenesis. To evaluate choroidal structural changes in patients with primary open-angle glaucoma (POAG) and primary angle-closure glaucoma (PACG) and healthy controls utilizing the choroidal vascularity index (CVI) and subfoveal choroidal thickness (SFCT) by enhanced depth imaging optical coherence tomography (EDI-OCT). This study was cross-sectional. A total of 171 eyes of 171 subjects, comprising 69 eyes with untreated POAG, 58 eyes with untreated PACG and 44 healthy eyes, were enrolled in this study. SFCT, luminal area (LA), stromal area (SA) and total choroidal area (TCA) were measured on EDI-OCT scans. The CVI parameter is calculated as the proportion of LA to TCA. This study included 69 POAG patients with a mean age of 51.4±13.3 years, 58 PACG patients with a mean age of 57.0±7.3 years, and 44 healthy subjects with a mean age of 51.11±10.7 years. The CVI in the POAG and PACG groups was significantly lower than that in the control group (P = 0.001 and P = 0.005, respectively), however not significantly different between the two glaucoma groups (P = 1.000). POAG eyes had significantly lower LA than PACG and controls (P = 0.014 and P = 0.049, respectively), while PACG eyes had significantly greater SA than controls (P = 0.041). The CVI of POAG and PACG eyes was significantly lower than that of normal eyes. A reduced LA was observed mainly in eyes with POAG, and an increased SA was observed mainly in eyes with PACG. The role of the choroid may differ between POAG and PACG eyes.

Value of disc topographic measurements for the discrimination of glaucoma suspects from early primary open angle glaucoma cases: A thin discriminative line

PurposeTo determine the diagnostic value of optic nerve head (ONH) topographic parameters measured by swept-source optical coherence tomography (SS-OCT) in differentiating between early glaucoma cases, glaucoma suspects (GSs), and healthy eyes. MethodsThe files of GSs, those with an early primary open angle glaucoma (POAG) diagnosis, and healthy eyes were retrospectively screened. Demographic characteristics, retinal nerve fibre measurements, visual field examinations, and ONH topographic parameters, including rim area, disc area, vertical and horizontal cup-to-disc ratios (CDRs), and cup volume, were compared between the groups. A receiver operating characteristic (ROC) curve analysis was performed on the ONH parameters. ResultsA total of 170 eyes from 85 GSs, 114 eyes from 57 patients with a diagnosis of early POAG, and 70 healthy eyes from 48 subjects were included in the study. The median age was 52.1 ± 0.9 years for the POAG group, 60.2 ± 1.1 years for the GS group, and 60.5 ± 1.6 for the controls. In the comparison of the ONH parameters between the groups, only rim area statistically significantly differed between the POAG and GS groups. However, all ONH parameters statistically significantly differed between the GS and control groups (p< 0.05). The mean rim areas of the GS, POAG, and control groups were 1.278 ± 0.055 mm2, 1.073 ± 0.065 mm2, and 1.446 ± 0.055 mm2, respectively, being statistically significantly higher in the controls and lower in the POAG group (p < 0.001). The highest area under the curve (AUC) value belonged to vertical CDR for the discrimination of the eyes with POAG from healthy eyes [0.806 (0.728–0.869, p < 0.001] and rim area for the discrimination of POAG cases and GSs [0.728 (0.650–0.797, p < 0.001]. ConclusionThere are significant differences in all ONH parameters between the eyes of GSs and healthy eyes. For the discrimination of early POAG and GS cases, topographic disc parameters may have value. In this study, rim area significantly differed between the GS and POAG groups, and it had the highest AUC value amongst the evaluated ONH parameters in the discrimination of early POAG cases S GSs.

Evaluation of inner retinal function at different stages of primary open angle glaucoma using the photopic negative response (PhNR) measured by RETeval electroretinography.

To investigate the objective function of the inner retinal layer in each stage of primary open angle glaucoma (POAG) using the photopic negative response (PhNR) measured by RETeval full-field electroretinography (ERG), and to identify which PhNR parameter is the most useful. Ninety eyes of 90 patients with POAG (30 with mild POAG (mean deviation (MD) ≥ -6dB) and 60 with moderate-to-advanced POAG (MD < -6dB)) and 76 eyes of 76 control cases were examined. We investigated six PhNR parameters and their relationships with the results of the Humphrey 30-2 visual field test and the thickness of the circumpapillary retinal nerve fiber layer (cpRNFL) obtained from optical coherence tomography. The following PhNR parameters were assessed: base-to-trough (BT), peak-to-trough (PT), 72msPhNR, the W-ratio, P-ratio, implicit time (IT), and a-wave and b-wave amplitudes on ERG. All PhNR parameters other than IT significantly differed between the all POAG (all stages) and control groups and between the moderate-to-advanced POAG and control groups. BT and 72msPhNR in the mild POAG group, significantly differed from those in the control group. Regarding the relationships between PhNR parameters and the visual field and between these parameters and cpRNFL thickness, correlations were observed between all PhNR parameters, except PT and IT, and both the visual field and cpRNFL thickness in the all and moderate-to-advanced POAG groups. 72msPhNR correlated with cpRNFL thickness in the mild POAG group. The area under the receiver operating characteristic curve was greater for BT than for the other PhNR parameters in both the mild and moderate-to-advanced POAG groups. The discriminant linear function for examining the presence or absence of POAG and the threshold for diagnosis were quantitatively obtained as follows. Regarding BT: discriminant = 0.505 × BT + 2.017; threshold = positive for POAG, negative for no POAG; correct answer rate = 80.7%. Concerning 72msPhNR: discriminant = 0.533 × 72msPhNR + 1.553; threshold = positive for POAG and negative for no POAG; correct answer rate = 77.1%. RETeval-measured PhNR parameters were useful for an objective evaluation of visual function in moderate-to-advanced POAG. BT appeared to be the most diagnostically useful parameter.

Comparison of Corvis ST Parameters between Primary Open-Angle Glaucoma and Primary Angle-Closure Glaucoma.

We compared corneal visualization Scheimpflug technology (CST) parameters between eyes with primary open-angle glaucoma (POAG) and primary angle-closure glaucoma (PACG). A retrospective analysis was performed on data from 89 eyes with POAG and 83 eyes with PACG that had CST examinations. CST parameters were compared between eyes with POAG and those with PACG using a linear mixed model (LMM). No differences were observed in age, central corneal thickness, intraocular pressure, or use of antiglaucoma eye drops between the two groups. Patients with PACG had a significantly shorter axial length (AL), a higher proportion of females, CST parameters, longer applanation 2 (A2) time, deeper A2 deformation amplitude, shorter peak distance, longer whole eye movement, and longer whole eye movement time than patients with POAG. The highest concavity (HC) length and PD showed a significant positive correlation with AL. However, A1 length, A1 deformation amplitude, A2 time, A2 velocity, A2 length, A2 deformation amplitude, HC time, whole eye movement, and whole eye movement time were negatively correlated with AL. The biomechanical properties of the cornea differed between POAG and PACG. In some parts, AL differences between the POAG and PACG groups might contribute to the variation in CST parameters.