Primary Open-angle Glaucoma Patients Research Articles

Vascular Density and Retinal Structure Relationships Across Sectors and Regions of the Optic Nerve in Patients with Primary Open Angle Glaucoma

Précis: The relationship between structural and hemodynamic parameters in patients with primary open angle glaucoma is strongest in the temporal region of the optic nerve. Purpose: To investigate the relationship between radial peripapillary capillary (RPC) vessel density (VD) and retinal nerve fiber layer (RNFL) thickness in quadrants and sectors of the optic nerve head (ONH) in patients with and without primary open angle glaucoma (POAG). Methods: In a cross-sectional prospective analysis, 191 subjects (80 early-stage POAG; 111 non-glaucomatous controls) were assessed for RNFL thickness and RPC VD in each quadrant [superior (S), inferior (I), nasal (N) and temporal (T)] and sector [inferior-temporal (IT), temporo-inferior (TI), temporo-superior (TS), superior-temporal (ST), inferior-nasal (IN), naso-inferior (NI), naso-superior (NS), and superior-nasal (SN) sectors] of the ONH via optical coherence tomography angiography (OCTA, Avanti, Optovue). Pearson correlations were used to test for associations between measurements, with P<0.05 considered statistically significant. Results: Significantly stronger positive correlations were found between RPC VD and RNFL thickness in the S, I, and T quadrants in POAG patients compared to non-glaucomatous controls (all P<0.05). The temporal quadrant in POAG patients displayed the largest difference in correlation compared to controls. A stronger positive correlation was also found between RPC VD and RNFL thickness in the temporal sectors of the ONH in POAG patients compared to controls, with the largest difference in the TS sector (all P<0.05). Conclusion: Early-stage POAG patients have a stronger relationship between RPC VD and RNFL in the temporal regions of the ONH compared to non-glaucomatous controls, with the TS sector demonstrating the largest difference between groups. Temporal sector VD loss may represent an early-stage biomarker for vascular-linked POAG disease.

Aqueous Angiography Guided Bent Ab Interno Needle Goniectomy in High versus Low Aqueous Humor Outflow Regions in POAG: A Pilot RCT.

Trabecular cutting minimally invasive glaucoma surgery like bent ab interno needle goniectomy (BANG) when performed in baseline aqueous angiography identified low aqueous humor outflow regions, results in greater success of intraocular pressure reduction. To study the efficacy of Bent Ab Interno Needle Goniectomy (BANG) in high versus low aqueous humor outflow (AHO) regions as determined by Aqueous Angiography(AA) in patients with primary open angle glaucoma (POAG). A prospective, single-centre, pilot, randomized control trial recruited 30 eyes of 30 patients of POAG and visually significant cataract (45-80y) and were randomised into two groups ("A": BANG performed in the high-flow regions and "B": BANG performed in the low-flow regions) of 15 each. AA was performed using indocyanine green dye (0.1%) to identify baseline high- and low-flow regions of the AHO pathways followed by BANG in these respective regions as per randomisation. Preoperative and postoperative data on IOP, number of antiglaucoma medications (AGMs) and any complications were noted over 6 months. Overall success was defined as achieving an IOP ≤15mm Hg and ≥6mm Hg at 6 months of follow-up with AGMs (qualified success) or without AGMs (complete success). AA revealed high-flow regions of AHO pathways in the nasal quadrant and low-flow regions of AHO pathways in the temporal quadrant in all 30 patients. Both groups had comparable demographic composition [group A age: 65.3±6.48y and male: female (14:1) and group B age: 64.6±7.08y and male: female (13:2)]. The mean preoperative IOPs [group A (17.27±3.43mm Hg); group B (17.60±5.42mm Hg)] (P=0.842) and mean postoperative IOP at 6 months [group A (15.6±4.98mm Hg); group B (13.13±2.29mm Hg)] (P=0.09) were similar. However, lower qualified success was seen in group A (40.00%) compared to group B (86.67%; P=0.021). Survival in Kaplan-Meier analysis was higher in group B (P=0.021). Complications were comparable in both groups. Short-term results of BANG in low-flow AHO regions show enhanced success compared to those in high-flow AHO regions. This study suggests that trabecular cutting minimally invasive glaucoma surgeries (like BANG) may be performed in baseline low-flow AHO regions (temporal quadrant) instead of the high-flow AHO (nasal quadrant) regions.

Aging-enhanced autophagy activity promotes fibrotic progression via the TGF-β2/Smad signaling pathway in trabecular meshwork cells—a new insight from POAG

IntroductionGlaucoma, a leading cause of irreversible blindness, is characterized by optic neuropathy and retinopathy, with primary open-angle glaucoma (POAG) being the most prevalent form. The primary pathogenic mechanism of POAG involves elevated intraocular pressure caused by chronic fibrosis of the trabecular meshwork (TM). Autophagy, a critical process for maintaining cellular homeostasis, has been implicated in fibrosis across various organs. However, its precise role in the fibrosis associated with POAG pathogenesis remains unclear. This study investigates the involvement of autophagy in TM fibrosis and explores its potential impact on POAG development, aiming to provide insights into new therapeutic targets.MethodsTo assess autophagy activity and its relationship with fibrosis, we analyzed TM tissues from POAG patients and healthy donors. Autophagic activity in human TM tissues was measured through immunohistochemical analyses. An in vitro aging model using chronic H2O2 treatment was established to investigate the change of fibrosis in TM cells. Additionally, we used dexamethasone-treated TM cells as a POAG model to explore the role of autophagy in fibrotic progression. The involvement of the TGF-β2/Smad signaling pathway was investigated through western blot analysis and quantitative real-time PCR.ResultsThis study reveals increased autophagic activity in tissues from POAG patients and an age-related upregulation of autophagy in healthy human TM tissues. In the H2O2-induced aging model, TM cells displayed both elevated autophagic activity and fibrosis. Further investigation showed that enhanced autophagy activity promoted fibrotic progression via activation of the TGF-β2/Smad signaling pathway. Similarly, in the dexamethasone-treated TM cell model, autophagy was found to exacerbate fibrosis, aligning with observations in the aging model.DiscussionIn this study, we uncover the interplay between autophagy and the TGF-β2/Smad pathway in the pathogenesis of POAG. We observed increased autophagic activity in TM tissues from POAG patients and in TM tissues of aging healthy individuals. In human primary TM cells, we confirmed that autophagy becomes activated in the context of cellular senescence and the development of POAG, which further facilitates fibrotic progression via the TGF-β2/Smad signaling pathway. These findings underscore the important role of autophagy in POAG pathogenesis and confirm senescence as a pivotal risk factor.

Comparison of glaucoma progression rate in glaucoma patients at different stages using guided progression analysis with optical coherence tomography

BackgroundThe aim of the present study was to compare the rates of change in Ganglion Cell- Inner Plexiform Layer (GCIPL) and Retinal Nerve Fiber Layer (RNFL) thickness, as measured by Optical Coherence Tomography (OCT) Guided Progression Analysis (GPA) program in control group, Primary Open Angle Glaucoma (POAG) and Pseudoexfoliation Glaucoma (PXG) eyes.Methods60 POAG and 60 PXG patients and 30 control group patients were included in the study. Patients diagnosed with glaucoma were divided into two groups as mild (Mean deviation (MD) > -6.00) and moderate-severe (MD < -6.00). The average, superior and inferior quadrant thinning rates (expressed in micrometers per year) of GCIPL and RNFL in the OCT GPA program were compared between groups.ResultsAverage GCIPL thinning rates were -0.23 ± 0.21 μm/year in the control group, -0.64 ± 0.54 μm/year in POAG patients, and -1.06 ± 1.16 μm/year in PXG patients (ANOVA, p < 0.001). Average RNFL thinning rates were -0.33 ± 0.44 μm/year in the control group, -0.86 ± 0.73 μm/year in POAG patients, and -1.33 ± 1.4 μm/year in PXG patients (ANOVA, p < 0.001).ConclusionsThe rates of GCIPL and RNFL thinning were highest in patients with PXG.We found that the glaucoma stage did not affect the rate of RNFL and GCIPL thinning.

Potential Functions and Causal Associations of GNLY in Primary Open-Angle Glaucoma: Integration of Blood-Derived Proteome, Transcriptome, and Experimental Verification.

Genome-wide association studies (GWAS) have identified multiple genetic loci associated with primary open-angle glaucoma (POAG). However, the mechanisms by which these loci contribute to POAG progression remain unclear. This study aimed to identify potential causative genes involved in the development of POAG. We utilized multi-dimensional high-throughput data, integrating proteome-wide association study(PWAS), transcriptome-wide association study (TWAS), and summary data-based Mendelian randomization (SMR) analysis. This approach enabled the identification of genes influencing POAG risk by affecting gene expression and protein concentrations in the bloodstream. The key gene was validated through enzyme-linked immunosorbent assay (ELISA) analysis. PWAS identified 86 genes associated with altered blood protein levels in POAG patients. Of these, eight genes (SFTPD, CSK, COL18A1, TCN2, GZMK, RAB2A, TEK, and GNLY) were identified as likely causative for POAG (P SMR < 0.05). TWAS revealed that GNLY was significantly associated with POAG at the gene expression level. GNLY-interacting genes were found to play roles in immune dysregulation, inflammation, and apoptosis. Clinical and cell-based validation confirmed reduced GNLY expression in POAG groups. This study reveals GNLY as a significant potential therapeutic target for managing primary open-angle glaucoma.

Pharmacotherapy, adverse drug reactions, and factors associated with clinical outcome in primary open-angle glaucoma

Background: Glaucoma is a chronic, progressive optic neuropathy caused by a group of ocular conditions which lead to damage of the optic nerve with progressive diminution of vision. Medical management is currently the primary line of treatment in primary open-angle glaucoma (POAG). Aim: The aim of this study was to determine the pattern of pharmacotherapy and the adverse drug reactions (ADRs) and factors associated with clinical outcomes in patients with POAG. Materials and Methods: This cross-sectional study involved 100 patients diagnosed with POAG satisfying inclusion criteria. The demographic, clinical, and treatment data along with ADRs to antiglaucoma drugs were noted. Descriptive statistics and Chi-square test were used to analyze the data. Results: The most commonly prescribed antiglaucoma medications were timolol (76%) and latanoprost (31%). The most common fixed-dose combination (FDC) prescribed was timolol + brimonidine (20%). Thirty-seven percentage of the patients needed switch over from initial medications and 16% needed add-on therapy by the end of 1 year. The most common ADR was redness of the eye (30.5%). The target intraocular pressure (IOP) was achieved in 65% of the patients after 3 months of treatment. It was found that target IOP was associated with gender and residence. Conclusion: Timolol was the most commonly prescribed antiglaucoma medication though it reported the highest number of ADRs. Timolol + brimonidine is the most commonly prescribed FDC. The target IOP was achieved in two-thirds of the POAG patients.

Navigating postoperative complications: Uveitis-glaucoma-hyphema syndrome after Ahmed glaucoma valve implantation.

Altwijri and Alsirhy reported a case of uveitis-glaucoma-hyphema syndrome after an Ahmed glaucoma valve implantation surgery in an advanced primary open-angle glaucoma patient, being the first ever recorded of its kind. The author describes the position of the tube as the origin of the anterior chamber inflammation and hyphema, which resolved shortly after shortening and relocating it. This publication emphasizes the importance of precise implant positioning and close-up patient follow-up after glaucoma filtration surgery as an important standard for healthcare providers.

Surgical Synergy in Primary Open-Angle Glaucoma: Assessing Safety and Efficacy of Hydrus, iStent, and Gonioscopy-Assisted Transluminal Trabeculotomy in Glaucoma Management.

Background/Objectives: This paper will compare the outcomes-safety and efficacy-of three minimally invasive glaucoma surgeries (MIGSs),the Hydrus Microstent, iStent, and Gonioscopy-Assisted Transluminal Trabeculotomy (GATT), for intraocular pressure (IOP) reduction in patients with primary open-angle glaucoma (POAG). Methods: A literature search of Ovid Medline and Embase identified studies evaluating the Hydrus, iStent, and GATT. Data on IOP reduction, medication use, and complications were analyzed. Results: Studies show the Hydrus, iStent, and GATT reduce IOP and medication burden in POAG patients, with some complications. For the Hydrus, studies showed 37.09% (27.5 ± 4.4 to 17.3 ± 3.7 mmHg) and 25% (16.8 to 12.6 mmHg) IOP reduction. Meanwhile, medication burden decreased from 2.5 ± 0.7 to 1.0 and from 2.1 to 1.15. For the iStent, studies showed a 36.39% (21.1 to 13.4 mmHg) and 8.19% (17.1 to 15.7 mmHg) IOP drop. Medication burden decreased from 2.87 to 1.24 and from 1.7 to 0.26. For GATT, studies showed a 49.33% (27.70 ± 10.30 to 14.04 ± 3.75) and 39.09% (26.40 ± 6.37 to 16.08 ± 2.38) IOP drop. Medication burden reduced from 3.73 ± 0.98 to 1.82 ± 1.47 and from 3.12 ± 0.80 to 0.45 ± 0.96. Conclusions: The Hydrus, iStent, and GATT are effective alternatives to trabeculectomy for mild to moderate POAG. They reduce and control IOP and dependence on medications with manageable safety profiles. In all three options, there were some clinically significant complications based on the p-value. For the Hydrus, it was PAS. For the iStent, they were PAS, FB sensation, IOP spikes, and microhyphema. For GATT, it was IOP spikes. However, further long-term studies, especially randomized controlled trials, are needed to support these results.

Analysis of SMOC2 gene variants in familial and non-familial primary open angle glaucoma Pakistani patients.

To find out the association of secreted protein acidic and rich in cysteine (SPARC)-related modular calcium binding 2 (SMOC2) gene variants rs2255680 and rs13208776 with genotypic and phenotypic characteristics in both familial and non-familial primary open angle glaucoma (POAG) patients. A total of 212 POAG patients, comprising 124 familial and 88 non-familial, were enrolled. For genotyping the SMOC2 variant rs2255680, amplification refractory mutation system (ARMS)-polymerase chain reaction (PCR) method and PCR-restriction fragment length polymorphism (PCR-RFLP) were utilized for analyzing rs13208776 variant. The mean age of familial POAG patients was 50.92±9.12y, with 78 males and 46 females. The mean age of non-familial POAG patients was 53.14±13.44y, with 52 males and 36 females. The SMOC2 gene variant rs13208776 showed the significant association with POAG between familial and non-familial groups. The homozygous G/G variant was frequent among non-familial (60.2%) whereas the heterozygous G/A variant was more frequent in familial POAG patients (46%). There were significant differences in G/A variant between familial and non-familial glaucoma patients, and the risk was decreased to 0.53-fold in non-familial glaucoma patients [odds ratio (OR): 0.53; 95% confidence interval (CI): 0.29-0.94; P=0.033] in codominant model. The risk was further reduced to 0.49-fold (95%CI: 0.28-0.86; P=0.012) in dominant model for non-familial patients. No significant association of SMOC2 gene variant rs2255680 between familial and non-familial glaucoma patients was found in our population. The haplotype analysis showed the decreased risk for TA [OR: 0.48 (95%CI: 0.29-0.79); P=0.004] and an increased risk for TG [OR=2.28 (95%CI: 1.22-4.25); P=0.01] haplotypes. Current findings show significant association of SMOC2 gene variant rs13208776 with POAG between familial and non-familial Pakistani patients.

Core genes and immune dysregulation in primary open-angle glaucoma: A molecular insight

Background Primary open-angle glaucoma (POAG) is a chronic, progressive and irreversible eye disease. Currently, there is no effective way to prevent optic nerve damage. Objective This study explored POAG gene markers to identify high-risk groups at an early stage and to find new effective therapeutic targets. Methods The mRNA and clinical information of POAG patients and normal samples were downloaded from the Gene Expression Omnibus (GEO) database. Through Weighted correlation network analysis (WGCNA) and generalized linear models (GLM), random forests (RF), support vector machines (SVM), and extreme gradient boosting (xGB) models, key risk genes were identified and an early diagnosis model was established. Functional enrichment analysis and CIBERSORT algorithm were used to further reveal the changes in the POAG immune environment and find emerging therapeutic targets. Results HERPUD1, IQCK, MRPL40, SRSF7 and TMEM243 were identified as risk genes, and the prediction model and nomogram constructed based on them had good early prediction efficiency. At the mechanistic level, the heterogeneity of T cell subsets seems to be a key factor affecting the progression of POAG and has potential therapeutic value. Conclusions HERPUD1, IQCK, MRPL40, SRSF7, and TMEM243 are of great significance for the early prediction and disease progression of POAG and have the potential value of becoming therapeutic targets.

Association Between Alcohol Use and Primary Open Angle Glaucoma.

In a diverse database (All of Us), we report significant dose-response associations between alcohol use frequency and glaucoma, with alcohol use of 4 or more drinks per week associated with significantly increased odds of glaucoma. Current evidence on the association between alcohol use and primary open angle glaucoma (POAG) is mixed. We utilize the diverse All of Us Research Program to further examine this relationship. This is a retrospective cohort study using the diverse All of Us Research Program, a nationwide effort by the United States National Institutes of Health to recruit those historically under-represented in biomedical research. Electronic health records and survey data from the All of Us program was analyzed. A randomized 1:4 case/control ratio was utilized for POAG patients and randomly selected control patients. Chi-Square, bivariable, and multivariable regression were utilized to examine the associations between alcohol use and POAG. Of the 3876 POAG patients, 2015 (52%) were female, 1943 (50%) were White, 1152 (30%) were Black, 117 (3%) were Asian, and 584 (15%) were Hispanic. Alcohol use of 4 or more drinks per week was significantly higher in the glaucoma cohort relative to controls (15% vs. 12%, P<0.001). On bivariate analysis, diagnosed alcohol misuse was associated with higher odds of POAG [Odds Ratio (OR): 1.20, 95% Confidence Interval (CI): 1.17-1.23, P<0.001]. In multivariable regression, more frequent alcohol use was associated with higher odds of glaucoma; alcohol use with a frequency of 4 or more drinks per week was significantly associated with increased odds of glaucoma (OR: 1.22, 95% CI: 1.03-1.44, P=0.023). This dose-response relationship was also observed and more pronounced for female participants, where alcohol use frequency of monthly or less was already associated with increase odds of glaucoma (OR: 1.21, 95% CI: 1.002-1.46, P=0.048). In the diverse All of Us database, there was a dose-response relationship between alcohol consumption and POAG risk, which was more pronounced in female participants. Overall, higher frequency of alcohol consumption was associated with increased risk of POAG; 4 or more drinks per week significantly was associated with higher glaucoma risk.

Effectiveness and safety of VISULAS® green selective laser trabeculoplasty: 12 months retrospective data

To report the safety and effectiveness of selective laser trabeculoplasty (SLT) using the SLT mode of the VISULAS® green laser in patients with primary open-angle glaucoma (POAG). Twelve months results are presented. Retrospective extension in 4 German centers of an initially prospective interventional multicenter 3-month clinical investigation using the VISULAS® green SLT (Carl Zeiss Meditec AG, Jena, Germany) in patients with POAG who either needed treatment escalation or commenced treatment and had an IOP ≥ 17mmHg at baseline, with no previous glaucoma or other ocular surgery. Non-overlapping laser spots (100) were applied in a single session to 360° of the trabecular meshwork (TM). Glaucoma medications were not changed up to the 3-month visit. From 3 to 12 months, patients were managed according to routine standard of care. Outcome measures included IOP reduction, further glaucoma interventions, and adverse events from baseline to month 12. 25 eyes of 25 POAG patients (mean age 65.8 ± 8.5; modified intention to treat – mITT –group) were included in the extension study. Six eyes (24%) underwent additional glaucoma treatment or changed glaucoma therapy; the remaining 19 eyes (76%) had stable glaucoma therapy (SGT group) with no further glaucoma intervention or change in glaucoma medications (mean number of preoperative glaucoma medications: 2.3 ± 1.34). In the SGT group, mean baseline IOP (mmHg) was reduced from 20.0 ± 2.11 at baseline to 17.4 ± 3.25 and 16.2 ± 1.83 at 6 to 12 months, respectively (p < 0.0001): 52.6% had ≥ 20% IOP reduction at 12 months. Potential device- or procedure-related adverse events were mild to moderate and resolved without sequelae. SLT performed with the VISULAS® green laser reduced IOP in eyes with POAG up to 12 months with no relevant safety issues. The results are comparable to other reported SLT studies.

Five-Year Outcomes of Deep Sclerectomy in Pseudoexfoliation Glaucoma Compared to Primary Open-Angle Glaucoma.

Objectives: This study aimed to investigate the five-year outcomes of deep sclerectomy (DS) in patients with pseudoexfoliation glaucoma (PEXG) and primary open-angle glaucoma (POAG). Methods: This retrospective, observational, unicentric study analyzed POAG and PEXG patients. Intraocular pressure (IOP), the number of IOP-lowering medications, peripapillary retinal nerve fiber layer (RNFL) thickness, the number of postoperative interventions, surgical success rates, and secondary surgery rates were evaluated at baseline and during follow-up appointments. Results: A total of 109 POAG and 153 PEXG eyes were included. Over the 5-year follow-up, IOP decreased in both groups (p = 0.17), from 22.8 ± 0.7 to 13.3 ± 0.6 mmHg (p < 0.001; POAG) and from 24.3 ± 0.8 to 16.6 ± 1.2 mmHg (p < 0.001; PEXG). The number of IOP-lowering medications decreased comparably (p = 0.99), from 3.1 ± 0.1 to 1.7 ± 0.3 (p = 0.001; POAG) and from 3.4 ± 0.1 to 1.7 ± 0.2 (p < 0.001; PEXG). Peripapillary RNFL thickness decreased in both groups (p = 0.31), from 60.6 ± 1.9 to 54.2 ± 2.4 µm (p < 0.001; POAG) and from 63.1 ± 1.7 to 58.0 ± 2.3 µm (p < 0.001; PEXG). The 5-year complete success rates were 33% and 12% for the POAG and PEXG groups, respectively (p = 0.01). The qualified success rates were 63% and 40% (p = 0.03). Secondary glaucoma surgery was required in 8% of POAG eyes and 21% of PEXG eyes (p = 0.04). Conclusions: DS resulted in comparable results for IOP, medications, and RNFL development in the PEXG and POAG groups but in less favorable outcomes concerning surgical success and further necessary repeated glaucoma surgery in patients with PEXG over the 5-year follow-up period.

Alterations in surface-based amplitude of low-frequency fluctuations primary open-angle glaucoma link to neurotransmitter profiling and visual impairment severity.

The study aimed to examine alterations in surface-based amplitude of low-frequency fluctuations (ALFF) and fractional amplitude of low-frequency fluctuations (fALFF) in primary open-angle glaucoma (POAG) patients using resting-state functional magnetic resonance imaging (rs-fMRI), and to investigate their relationships with visual function and molecular profiling. A total of 70 POAG patients and 45 age- and sex-matched healthy controls (HCs) underwent rs-fMRI scans. The differences between POAG and HCs groups were compared by two-sample t-test. Spearman's correlation analyses assessed the relationship between ALFF/fALFF values and ophthalmic parameters. Spatial correlation analysis of the patients-control difference map with brain imaging data further explores underlying neurobiological mechanisms. POAG patients displayed altered brain activity compared to HCs, including decreased ALFF/fALFF in the visual network and increased in the frontoparietal and default mode networks. They exhibited reduced fALFF in the somatomotor network and increased ALFF in the dorsal and ventral attention networks. These changes are linked to neurotransmitter systems, with fALFF particularly associated with the dopamine system. Moreover, the altered ALFF/fALFF in brain regions related to vision and attention - the occipital lobe, temporal lobe, parietal lobe, paracentral lobule, and frontal lobe correlated with ophthalmic examination parameters. Surface-based ALFF/fALFF in POAG decreased in visual processing regions and increased in brain regions related to cognitive control, working memory, and attention. These changes were linked to neurotransmitter distributions important for emotional stability and mental health, potentially informing treatment approaches for POAG patients.

Assessment of Choroidal thickness in primary open angle glaucoma patients, an OCT study

Assessment of Choroidal thickness in primary open angle glaucoma patients, an OCT study

Changes in prostaglandin-associated periorbital syndrome: a self-controlled and prospective study

Introduction In this study, we aimed to investigate the incidence of objective and subjective indicators of the prostaglandin-associated periorbital syndrome (PAPS) after continuous instillation of topical prostaglandin analogues (PGAs) in primary open-angle glaucoma or ocular hypertension patients. Methods A self-controlled and prospective study of PGA instillation was performed in patients (n = 55) with primary open-angle glaucoma or ocular hypertension. Bilateral instillation of bimatoprost, travoprost, latanoprost, or tafluprost was conducted (treatment, 3–6 months). The objective indicators recorded included interpupillary distance (IPD) and exophthalmos; subjective indicators were assessed via colour pictures of the periocular area. Data from before the administration of medication served as controls. Posttreatment changes in IPD, exophthalmos, deepening of the upper eyelid sulcus, periorbital hyperpigmentation and eyelash growth were analysed. Results Compared with those before treatment, the interpupillary distance (IPD) differed from the baseline value at 1 month after treatment (P < 0.0001), and the exophthalmos only significantly differed from the baseline value at month 3 (P = 0.0005). Visible periorbital changes at 1, 3, and 6 months after treatment were assessed, and the incidence of eyelash growth and thickening was 7.27%, 45.45% and 66.67%, respectively. The incidence of periorbital hyperpigmentation was 7.2%, 18.18% and 33.33%, respectively. The incidence of upper-eyelid sulcus deepening was 3.64%, 7.27% and 16.27%, respectively. Bimatoprost had the highest incidence of PAPS, followed by travoprost and tafluprost, and latanoprost had the lowest incidence after three months of treatment in the between-group comparison. Conclusion As an objective index to evaluate PAPS, the change of IPD was more obvious than the exophthalmos. Visible periorbital changes gradually appeared after three months of medication. Bimatoprost caused the most severe PAPS, and latanoprost caused the least severe PAPS. Trial registration The study was registered at www.chictr.org.cn on 15 April 2021, under the identifier ChiCTR2100045465.

Assessing Serum Lipid Levels in Patients Diagnosed With Primary Open-Angle Glaucoma.

The main purpose of this study is to assess serum lipid levels in patients diagnosed with primary open-angle glaucoma (POAG). The secondary objective is to explore the association between these lipid levels, namely serum cholesterol, serum triglycerides, serum low-density lipoprotein (LDL), and serum high-density lipoprotein (HDL), and the development of POAG. Glaucoma is a major contributor to global blindness, with elevated intraocular pressure as a key risk factor. However, in some cases, the disease advances even when pressure levels are well controlled, suggesting that additional independent risk factors may play a role in its development. Previous epidemiological studies have shown a potential link between serum lipids and glaucoma, but the findings are contradictory, leading to this investigation into the relationship between serum lipid levels and POAG. The study involved 60 patients with POAG and a control group of 60 individuals without POAG. All individuals underwent a detailed ophthalmic examination, and fasting serum lipid levels were measured, including total serum cholesterol, serum triglycerides, LDL, and HDL. The lipid levels of the glaucoma group were then compared to those of the control group. The findings revealed that total cholesterol, triglycerides, and LDL levels were significantly higher in POAG patients compared to the control group (p < 0.05). Although HDL levels were lower in POAG patients, the difference was not statistically significant. Dyslipidemia appears to be an independent risk factor for POAG, with higher serum lipid levels strongly linked to the presence of the condition.

The Effect of Latanoprostene Bunod 0.024% on Optical Coherence Tomography Angiography in Newly Diagnosed Open Angle Glaucoma.

The aim of this study was to investigate the effect of topical latanoprostene bunod 0.024% applied once daily on intraocular pressure and macular vessel density in newly diagnosed primary and pseudoexfoliative open angle glaucoma patients. A total of 66 patients with newly diagnosed open angle glaucoma were included in this study (group 1). Thirty-four patients had primary (POAG, group 1A) and 32 patients had secondary (pseudoexfoliative glaucoma, PXG, group 1B) open angle glaucoma. Thirty-two healthy participants (group 2) were included in this single-center, prospective study. In group 1, the mean IOP decrease in first month of treatment with LBN was 7.7mm Hg and IOP change was -30.8%. In the superficial slab, the vessel density (VD) in the superior and nasal quadrants was lower in group 1B compared to group 1A in the first month of treatment (P=0.038, P=0.019, respectively). In the choriocapillaris slab, the VD in the superior quadrant at baseline (before treatment) was statistically lower in both groups compared to the VD in the superior quadrant in the first month of treatment (P<0.001, for both). In conclusion, treatment with LBN ophthalmic solution 0.024% reduced IOP by an average of 29.9% and 31.8% in patients with POAG and PXG, respectively, and improved VD in different quadrants in all slabs. Therefore, the importance of LBN in the treatment of glaucoma is likely to be that it increases macular microcirculation, possibly via NO, independent of its IOP-reducing effect.

Clinical profile of newly diagnosed glaucoma patients in Brazil

PurposeDescribe clinical characteristics of newly diagnosed glaucoma patients and identify risk factors associated with advanced stage of glaucoma. DesignRetrospective multicenter study. MethodsWe included patients over 18 years old with newly diagnosed glaucoma in 6 medical centers from different regions of Brazil. We applied logistic regression to assess odds ratios (OR) to identify risk factors for the patient to present advanced stage of glaucoma at diagnosis. ResultsWe included a total of 523 glaucoma patients. Mean age at the time of diagnosis was 64.5 years (± 12.4 years), with the majority being Caucasian (82.94 %). We found that 20 % of patients had advanced disease at diagnosis, with a low vision prevalence of 4.21 %. In the multivariable logistic regression, we found that older patients [odds ratio (OR) = 1.04 per year; 95 % confidence interval (CI):1.02–1.06; P < 0.001) and patients with higher intraocular pressure (IOP) at baseline (OR = 1.08 per mmHg; 95 % CI: 1.04–1.12; P < 0.001) were at higher risk to present advanced disease at diagnosis. In contrast, normal tension glaucoma patients (OR = 0.13; 95 % CI: 0.00–00.20; P = 0.024) had lower risk to present advanced disease at diagnosis. From the total of 523 patients, 366 (70.2 %) were diagnosed with primary open angle glaucoma (POAG). Within this subgroup of POAG patients, we found that older patients (OR = 1.04 per year; 95 % CI:1.01–1.06; P = 0.001), patients with higher IOP at baseline (OR = 1.09 per mmHg; 95 % CI: 1.04–1.15; P < 0.001) and patients with high myopia (spherical equivalent < -6 diopters, if phakic; or axial length > 26.5 mm, if pseudophakic) (OR = 3.39; 95 % CI: 1.35–8.42; P = 0.009) were at higher risk to present advanced disease at diagnosis. ConclusionsWe found that 20 % of patients had advanced disease at diagnosis, with a low vision prevalence of 4.21 %. We have showed that patients with older age and high IOP at baseline were at higher risk to present advance glaucoma at diagnosis. Within the subgroup of POAG, we found that patients with high IOP at baseline, older age, and high myopia were at higher risk of presenting advanced glaucoma at diagnosis, highlighting the importance of monitoring patients with these clinical characteristics.

Effects of SIPA1L1 on trabecular meshwork extracellular matrix protein accumulation and cellular phagocytosis in POAG.

Accumulation of extracellular matrix (ECM) proteins in trabecular meshwork (TM), which leads to increased outflow resistance of aqueous humor and consequently high intraocular pressure, is a major cause of primary open-angle glaucoma (POAG). According to our preliminary research, the RapGAP protein superfamily member, signal-induced proliferation-associated 1-like 1 protein (SIPA1L1), which is involved in tissue fibrosis, may have an impact on POAG by influencing ECM metabolism of TM. This study aims to confirm these findings and identify effects and cellular mechanisms of SIPA1L1 on ECM changes and phagocytosis in human TM (HTM) cells. Our results showed that the expression of SIPA1L1 in HTM cells was significantly increased by TGF-β2 treatment in label-free quantitative proteomics. The aqueous humor and TM cell concentration of SIPA1L1 in POAG patients was higher than that of control. In HTM cells, TGF-β2 increased expression of SIPA1L1 along with accumulation of ECM, RhoA, and p-cofilin 1. The effects of TGF-β2 were reduced by si-SIPA1L1. TGF-β2 decreased HTM cell phagocytosis by polymerizing cytoskeletal actin filaments, while si-SIPA1L1 increased phagocytosis by disassembling actin filaments. Simultaneously, overexpressing SIPA1L1 alone exhibited comparable effects to that of TGF-β2. Our studies demonstrate that SIPA1L1 not only promotes the production of ECM, but also inhibits its removal by reducing phagocytosis. Targeting SIPA1L1 degradation may become a significant therapy for POAG.