Pseudoexfoliation Glaucoma Patients Research Articles

Evaluation of corneal densitometry values with Pentacam in cases of ocular hypertension and pseudoexfoliative glaucoma

BackgroundExamination of corneal densitometry measurements using the Pentacam Scheimpflug imaging system in cases of pseudoexfoliative glaucoma (PEXG) and ocular hypertension (OHT). MethodsThe study included 50 eyes of 29 PEXG patients, 25 eyes of 16 OHT patients, and 76 eyes of 38 healthy control subjects followed in the glaucoma clinic. Corneal densitometry values of all cases were measured using the Scheimpflug imaging system (Pentacam, Oculus, Germany). Corneal densitometry was assessed based on 4 concentric radial zones (0–2 mm, 2–6 mm, 6–10 mm, and 10–12 mm) and depths (anterior, central, posterior, and total) within the Scheimpflug imaging system. The results were statistically analyzed. ResultsCorneal densitometry values examined between the OHT and control groups were higher in OHT and statistically significant (p < 0.05). Corneal densitometry values examined between the PEXG and control groups were higher in PEXG and statistically significant (p < 0.05). In comparison between the PEXG and OHT groups, corneal densitometry values in the central 0–2 mm, 2–6 mm, and 6–10 mm; posterior 0–2 mm and 2–6 mm radial zones were higher in PEXG and statistically significant (p < 0.05). ConclusionsIt was observed that elevated intraocular pressure levels in OHT cases could lead to changes in the cornea, consequently increasing corneal densitometry values. The higher corneal densitometry values in PEXG cases compared to OHT were attributed to the accumulation of pseudoexfoliative material in the cornea. Based on our study, corneal densitometry could serve as a potential biomarker for early glaucoma detection in OHT cases and could be employed to assess corneal transparency during the follow-up of PEXG cases.

Assessing the Efficacy of the PAUL Glaucoma Implant in Pseudoexfoliative Glaucoma.

The aim of the study was to evaluate the outcomes and complications associated with PAUL glaucoma implant (PGI) surgery in pseudoexfoliation glaucoma (PXG) patients, comparing them with a primary open-angle glaucoma (POAG) control group. A retrospective analysis included 39 PXG and 29 POAG eyes undergoing PGI surgery between January 2020 and December 2022. Surgical success was defined as intraocular pressure (IOP) between ≤21 and ≥6 mmHg at 12 months and no loss of light perception. Demographic data, ocular examinations, and complications were recorded. PXG patients (68.5±9.9 years) differed significantly in age from POAG patients (54.1±10.6 years) (p<0.05). Surgical success rates at 12 months were 97.4% (PXG) and 86.2% (POAG). No significant inter-group differences in gender, laterality, lens status, vertical cup/disc ratio, or pre-operative best-corrected visual acuity were observed. Mean IOP comparisons showed significant differences within both groups (p<0.001). Ripcord suture removal occurred at mean 30.3±7.43 days (PXG) and 30.6±9.89 days (POAG). Median pre-operative AGM use was 4 (PXG) and 3 (POAG). No significant differences were noted postoperatively. To the best of our knowledge, this is the first study to evaluate the results of PGI in PXG and POAG, demonstrating a remarkable success rate and limited complications. Encouragingly, PXG patients with a history of unsuccessful filtration surgery demonstrated positive outcomes. The findings affirm PGI as a promising surgical intervention for PXG and POAG, exhibiting high success rates and manageable complications.

Capacidad diagnóstica de la densidad vascular papilar y macular frente a parámetros estructurales con tomografía de coherencia óptica en el glaucoma seudoexfoliativo

PurposeTo evaluate the diagnostic ability of the vessel density (VD) of the optic nerve head (ONH) and the macula on optical coherence tomography (OCT) angiography and the retinal nerve layer thickness (RNFL) thickness and the macular ganglion cell complex (GCC) thickness on OCT in patients with pseudoexfoliative glaucoma (PXG). MethodsCross-sectional study including PXG patients and healthy controls. Demographic and clinical data were noted for all participants. Optical coherence tomography (OCT) and OCT angiography (OCTA) images of the ONH and macular area were obtained with the RS-3000 Advance OCT (Nidek Co., Gamagori, Japan). The RNFL and GCC thickness of different sectors was provided by the software. Macular VD of the superficial capillary plexus (SCP) and ONH VD of the radial peripapillary capillary plexus (RPCP) were registered. Groups were compared and area under the receiver operating characteristic (AUROC) curves were used to determine the power of discrimination of each parameter. ResultsRNFL and GCC thickness and ONH and macular VD were significantly lower in PXG patients compared with healthy controls (all, P<.05). The best discrimination parameter was the average RNFL thickness (AUROC: 0.928). ONH VD AUROC was better than that of macular VD (AUROC: 0.897 and 0.780, respectively). ONH VD AUROC was comparable to RNFL thickness (P<.001). ConclusionsThe diagnostic ability of ONH vessel density in PXG appears comparable to that of the structural parameters, RNFL and GCC thickness, obtained with OCT, and may be a valuable tool in clinical practice.

Diagnostic ability of vessel density of the optic nerve head and macula versus structural parameters with optical coherence tomography in pseudoexfoliative glaucoma

PurposeTo evaluate the diagnostic ability of the vessel density (VD) of the optic nerve head (ONH) and the macula on optical coherence tomography (OCT) angiography and the retinal nerve layer thickness (RNFL) thickness and the macular ganglion cell complex (GCC) thickness on OCT in patients with pseudoexfoliative glaucoma (PXG). MethodsCross-sectional study including PXG patients and healthy controls. Demographic and clinical data were noted for all participants. Optical coherence tomography (OCT) and OCT angiography (OCTA) images of the ONH and macular area were obtained with the RS-3000 Advance OCT (Nidek Co., Gamagori, Japan). The RNFL and GCC thickness of different sectors was provided by the software. Macular VD of the superficial capillary plexus (SCP) and ONH VD of the radial peripapillary capillary plexus (RPCP) were registered. Groups were compared and area under the receiver operating characteristic (AUROC) curves were used to determine the power of discrimination of each parameter. ResultsRNFL and GCC thickness and ONH and macular VD were significantly lower in PXG patients compared with healthy controls (all, p<0.05). The best discrimination parameter was the average RNFL thickness (AUROC: 0.928). ONH VD AUROC was better than that of macular VD (AUROC: 0.897 and 0.780, respectively). ONH VD AUROC was comparable to RNFL thickness (p<0.001). ConclusionsThe diagnostic ability of ONH vessel density in PXG appears comparable to that of the structural parameters, RNFL and GCC thickness, obtained with OCT, and may be a valuable tool in clinical practice.

The Differences in the Pattern of OCT and OCTA Examinations between Early Normal- and High-Tension Pseudoexfoliative Glaucoma.

Purpose. The aim of this study was to compare the results of optical coherence tomography angiography (OCTA) and optical coherence tomography (OCT) examinations in patients with normal-tension glaucoma (NTG) in comparison to high-tension pseudoexfoliative glaucoma (HTG) patients at the early stage of glaucoma. Material and methods. The studied groups consisted of patients in the early stage of NTG (70 eyes) and the early stage of HTG (71 eyes). In NTG and HTG groups, a detailed ophthalmic examination was performed. Optic disc OCT with peripapillary RNFL measurements and OCTA examination with the evaluation of the macula and optic disc were performed for all participants using Zeiss Cirrus 5000. Results. NTG and HTG groups were statistically similar as far as the MD was concerned, and both groups had early glaucoma. When evaluating the RNFL thickness, the only statistical difference between early NTG and HTG was observed in the thicknesses in the temporal sector of peripapillary RNFL, with thinner values in the NTG group (53.94 vs. 59.94, p = 0.0071). When the OCTA results of the macula and optic disc were evaluated, there were no statistical differences between early NTG and HTG. Conclusions. The vascular density and flow parameters assessed in OCTA were equal between early NTG and HTG, and therefore the involvement of vascular factors in NTG pathogenesis could not be confirmed. Our results confirm the preponderance of more frequent temporal RNFL involvement in early NTG.

Audiometric Evaluation of the Relationship between Sensorineural Hearing Loss and Chronic Glaucoma.

To assess hearing function in chronic glaucoma patients in comparison to healthy individuals. This cross-sectional study included 24 primary open-angle glaucoma (POAG) patients (24 ears) and 22 pseudoexfoliative glaucoma (PEG) patients (22 ears) who were followed for at least 5 years in the Afyonkarahisar Health Sciences University Ophthalmology Department, as well as 21 age- and gender-matched healthy individuals (21 ears, control group). Following a thorough ophthalmological examination that included visual acuity and intraocular pressure measurements, as well as anterior and posterior slit-lamp biomicroscopy, audiometry was performed in all participants to determine hearing function. Mean ages in the POAG, PEG, and control groups were 64.50±7, 66.90±4.51, and 64.38±4.36 years, respectively. The mean deviation in standard automated perimetry was -14.47±2.89 in the POAG group and -15.02±2.87 in the PEG group (p=0.306). When compared with the control group, the POAG group had significantly higher hearing thresholds at 500 (p=0.011) and 1,000 Hz (p=0.003), while the PEG group had significantly higher hearing thresholds at 250 (p=0.009), 500 (p=0.009), 1,000 (p=0.001), 2,000 (p=0.005), 4,000 (p=0.001), 8000 (p=0.010), and 10,000 Hz (p=0.009). Both glaucoma and hearing loss are common chronic diseases that have an impact on the well-being of older people. Potential hearing problems in chronic glaucoma patients make routine ocular and otolaryngology examinations in older patients critical for prompt diagnosis and treatment.

Twenty Novel MicroRNAs in the Aqueous Humor of Pseudoexfoliation Glaucoma Patients

The microRNAs (miRNAs) are short non-coding RNAs (19-25 nt) that regulate the level of gene expression at the post-transcriptional stage. Altered miRNAs expression can lead to the development of various diseases, e.g., pseudoexfoliation glaucoma (PEXG). In this study, we assessed the levels of miRNA expression in the aqueous humor of PEXG patients using the expression microarray method. Twenty new miRNA molecules have been selected as having the potential to be associated with the development or progression of PEXG. Ten miRNAs were downregulated in PEXG (hsa-miR-95-5p, hsa-miR-515-3p, hsa-mir-802, hsa-miR-1205, hsa-miR-3660, hsa-mir-3683, hsa -mir-3936, hsa-miR-4774-5p, hsa-miR-6509-3p, hsa-miR-7843-3p) and ten miRNAs were upregulated in PEXG (hsa-miR-202 -3p, hsa-miR-3622a-3p, hsa-mir-4329, hsa-miR-4524a-3p, hsa-miR-4655-5p, hsa-mir-6071, hsa-mir-6723-5p, hsa-miR-6847-5p, hsa-miR-8074, and hsa-miR-8083). Functional analysis and enrichment analysis showed that the mechanisms that can be regulated by these miRNAs are: extracellular matrix (ECM) imbalance, cell apoptosis (possibly retinal ganglion cells (RGCs)), autophagy, and elevated calcium cation levels. Nevertheless, the exact molecular basis of PEXG is unknown and further research is required on this topic.

Investigating the association of IL12B and INFG Polymorphisms with the risk of pseudoexfoliation syndrome and glaucoma

Background: Immune responses may be involved in the development of pseudoexfoliation (PEX), pseudoexfoliation glaucoma (PEXG), and primary open-angle glaucoma (POAG) pathogenesis. The aim of the present study was to evaluate the association of IL12B rs3212227 A/C and INFG rs1861494 T/C polymorphisms with the risk of PEX, PEXG, and POAG in an Iranian population. Methods: Totally, 55 POAG, 57 PEX, and 78 PEXG patient cases as well as 79 healthy controls were included in this study. Genotyping of the IL12B and INFG polymorphisms was performed by polymerase chain reaction and restriction fragment length polymorphism methods using TaqI and FauI restriction enzyme, respectively. Results: Results indicated that IL12B AC genotype was significantly higher in POAG (36.4%; P < 0.001; odds ratio [OR] = 4.0, 95% confidence interval [CI]: 1.7–10.0) and PEX patients (36.4%; P = 0.023; OR = 2.7, 95% CI: 1.1–6.9) compared to the control group (12.6%). The C allele could be considered a risk factor for POAG (P = 0.002; OR = 3.1, 95% CI: 3.1–6.8) and PEX (P < 0.001; OR = 3.4, 95% CI: 3.4–7.3). INFG TC genotype was significantly higher in PEX (38.6%; P = 0.007; OR = 2.8, 95% CI: 1.3–6.3) and PEXG patients (37.2%; P = 0.009; OR = 2.7, 95% CI: 1.1–6.9) compared to the control group (19.0%). The C allele seemed to be a risk factor for PEX (P = 0.002; OR = 2.8, 95% CI: 1.4–5.7) and PEXG (P = 0.009; OR = 2.4, 95% CI: 1.2–4.7). Conclusion: Overall, IL12B was associated with susceptibility to POAG and PEX, and IL12B C allele increased the risk of POAG and PEX. In addition, INFG was associated with susceptibility to PEX and PEXG, and the INFG C allele seemed to be a risk factor for PEX and PEXG.

Quality of life of patients with primary open-angle glaucoma, primary angle closure glaucoma, and pseudoexfoliation glaucoma in Central Serbia

Background/Aim. Impaired vision resulting from glaucoma can have deleterious effects on both physical and mental health. This study aims to examine the adverse im-pacts of primary open-angle glaucoma (POAG), primary angle closure glaucoma (PACG), and pseudoexfoliation glaucoma (PEG) on the quality of life (QoL) in Central Serbia. Methods. This research, designed as a cross-sectional study, included 102 patients treated for POAG, PACG, or PEG. The patients were divided into three groups (POAG, PACG, and PEG) based on the type of glaucoma they suffered from and were monitored for six months. The data on the QoL were obtained with the National Eye Institute Visual Functioning Questionnaire 25 (NEI VFQ-25). Using the appropriate algorithm, the total NEI VFQ-25 scores were calculated for each group. Results. The questionnaire showed that scores for general vision were significantly lower in the PEG group than in the other two groups (PEG: 61.1 ? 12.6; POAG: 71.6 ? 17.9; PACG: 75.7 ? 11.6), p &lt; 0.001. General health, eye pain, distance vision, social functioning, peripheral vision, reduced ability in daily activities, and dependence on others were also statistically significantly lower in the PEG group. The highest value of near vision was recorded for the POAG group (76.2 ? 21.2). The highest mean value in glaucomatous visual field defect was recorded in the PEG group (14.5 ? 3.6 dB). Conclusion. This research has demonstrated that the QoL is significantly lower in patients suffering from PEG compared to those suffering from POAG and PACG. Concerning the general health of patients, eye pain, distance vision, as well as the domain of social and everyday functioning, the lowest scores for individual areas of examination according to the NEI VFQ-25 were recorded in PEG patients. The results indicate that serious measures should be taken in order to improve the QoL of glaucoma patients.

Dermatological Findings in Glaucoma Patients: Comparison Between Pseudoexfoliative and Primary Open-angle Glaucoma.

To compare the frequency of dermatological manifestations between patients with pseudoexfoliative glaucoma and those with primary open-angle glaucoma. A cross-sectional study was done on all consecutive pseudoexfoliative glaucoma (PEXG) and primary open-angle glaucoma (POAG) patients evaluated in a tertiary eye hospital during the study period. Eligible patients were referred to the dermatology department for complete skin, hair, nail, and mucosal examinations. Twenty-one patients in the PEXG group and 26 patients in the POAG group were included in this study. The most common skin manifestations in the study were seborrheic dermatitis, dry skin, and cherry angioma. The frequency of lentigines was significantly higher in the PEXG patients than in the POAG group (P = 0.013). More than half of the study population had seborrheic dermatitis (57.1% and 61.5% in the PEXG and POAG groups, respectively); however, the difference between the groups was not statistically significant (P = 0.775). Similarly, the frequencies of skin dryness, cherry angioma, nevus, psoriasis, contact dermatitis, itching, seborrheic keratoses, notalgia paresthetica, and vitiligo in the two groups were not statistically significantly different (P 0.1 for all comparisons). There was no significant association between the frequency of the investigated skin manifestations and patients' age, visual acuity, intraocular pressure, and cup-to-disc ratio. Integumentary system disorders are pervasive in glaucoma patients, and dermatologic evaluation in glaucoma patients should be considered for diagnostic and therapeutic purposes.

Aqueous humor and serum levels of 4-hydroxynonenal and 8-hydroxy-2'deoxyguanosine in pseudoexfoliation syndrome and glaucoma.

To compare the aqueous humor (AH) and serum levels of 4-hydroxynenal (4-HNE) and 8-hydroxy-2'-deoxyguanosine (8-OhdG) in patients with pseudoexfoliation syndrome (PES) and pseudoexfoliation glaucoma (PEG) with each other and with age- and sex-matched control group. Thisprospective study included 66patientsdivided into three groups:PES (n = 24), PEG (n = 21), and acontrol group (n = 21). 4-HNEand 8-OhdG levelswere analyzed using theenzyme-linked immunosorbent assay. Aqueous and serum 4-HNE levels were significantly higher inthe PEG(466.52 ± 62.12pg/mL and313.47 ± 47.41pg/mL) and PES (290.69 ± 63.63pg/mL and201.53 ± 39.57pg/mL) groups than the control group (144.02 ± 39.58pg/mL and99.10 ± 16.96pg/mL;p < 0.001, for all). Both aqueous and serum levels of 4-HNE in the PEG group were significantly higher than in the PES group (p < 0.001, for both). Similar to 4-HNE, the AH 8-OhdG levelswere higher in the PEG group (21.18 ± 2.23ng/mL) compared to the PES (14.90 ± 3.37ng/mL) and control(4.86 ± 1.94ng/mL) groups(p < 0.001, for all).Serum 8-OhdG levels were significantly higher in the PEG and PES groups than the control (p < 0.001, for both); however,there was no significant difference between the PES andPEG groups (p = 0.097). There were strong significant correlations between the aqueous and serum levels of 4-HNE (p < 0.001, r = 0.857) and 8-OhdG (p < 0.001, r = 0.807) amongall the patients. Aqueous humor and serum levels of 4-HNE and 8-OhdG increased in the PES and PEG patients. These findings are potentially significant and add to the growing body of evidence concerning oxidative stress in PES and PEG.

Small Nucleolar RNAs in Pseudoexfoliation Glaucoma.

Small nucleolar RNAs (snoRNAs) are small non-coding regulatory RNAs that have been investigated extensively in recent years. However, the relationship between snoRNA and glaucoma is still unknown. This study aims to analyze the levels of snoRNA expression in the aqueous humor (AH) of patients with pseudoexfoliation glaucoma (PEXG) compared to a control group and identify hypothetical snoRNA-dependent mechanisms contributing to PEXG. The AH was obtained from eighteen Caucasian patients, comprising nine PEXG and nine age-matched control patients. RNA was isolated, and a microarray system was used to determine the snoRNA expression profiles. Functional and enrichment analyses were performed. We identified seven snoRNAs, SNORD73B, SNORD58A, SNORD56, SNORA77, SNORA72, SNORA64, and SNORA32, in the AH of the PEXG and control group patients. Five snoRNAs showed statistically significantly lower expression in the PEXG group, and two snoRNAs had statistically significantly higher expression in the PEXG group compared to the control group. In addition, we identified two factors—CACNB3 for SNORA64 and TMEM63C for SNORA32, similar to PEX-related genes (CACNA1A and TMEM136). The enrichment analysis for four genes targeted by snoRNAs revealed possible mechanisms associated with glaucoma and/or PEX, but the direct role of snoRNAs in these biological processes was not proven.

Assessment of Risk Factors for Advanced Open Angle Glaucoma Presentation among Patients Visiting Jimma University Medical Center, Jimma, Ethiopia.

Glaucoma is the predominant cause of irreversible blindness, particularly the late presentation. The purpose of this study is to identify the risk factors associated with late presentation in Jimma University Medical Center. A case-control study was done among patients newly diagnosed to have open angle glaucoma (of any type) at Jimma University Medical Center from July 2014 - January 2019. Cases were patients/eyes diagnosed to have any type of open angle glaucoma with advanced glaucomatous disc features, whereas controls were patients diagnosed with early and moderate stages of glaucoma. There were 205 (116 cases and 89 controls) participants. The mean age of the participants at the time of diagnosis was 58.3±13.4yrs. Family history of blindness, presenting IOP, type of glaucoma and age were independently associated with late presentation. Patients with family history of blindness had late advanced glaucoma five times higher than those with no family history of blindness. The presence of late glaucoma among patients with presenting intra ocular pressure < 30mmHg is lower than those having ≥30mmHg (Adjusted Odds Ratio= 0.136). Primary open-angle glaucoma patients were less likely to present with advanced glaucoma than pseudoexfoliative glaucoma patients (Adjusted Odds Ratio=0.39). The chance of presenting with late glaucoma was increased by 3.4% for every one year increment of age. Presence of family history of blindness, high presenting intraocular pressure, pseudoexfoliative glaucoma and old age are risk factors for late presentation of glaucoma.

Optical Coherence Tomography Angiography Findings in Primary Open-Angle and Pseudoexfoliation Glaucoma.

Objectives:To compare the optical disc and macular vascular density values of patients with glaucoma and healthy individuals by using optical coherence tomography angiography and evaluate the relationship between structural and functional test results and vascular density.Materials and Methods:The study included 128 eyes in total: 31 with pseudoexfoliation glaucoma (PEG), 55 with primary open-angle glaucoma (POAG) and similar visual field defects, and 42 healthy eyes. Whole image peripapillary vessel density (wpVD), intradisc vessel density (idVD), peripapillary vessel density (pVD), whole image macular vessel density (wmVD), and parafoveal vessel density (pfVD) values were compared between the groups. Correlations between visual field findings, retinal nerve fiber layer (RNFL) and optic nerve head measurements and peripapillary and macular vascular density were analyzed.Results:In the PEG and POAG groups, wpVD, idVD, wmVD, and pfVD values were significantly lower in than the control group. In the PEG group, wpVD was found to be significantly lower than the POAG group (p<0.001). There was no significant difference between the PEG and POAG groups in wmVD and pfVD except for nasal pfVD. There were strong positive correlations between RNFL thickness and pVD in the glaucoma groups (p<0.001). Significant correlations were found between visual field mean deviation and pattern standard deviation values and peripapillary and macular vessel density values in the glaucoma groups.Conclusion:Vascular density values were lower in glaucoma patients compared to normal individuals, and there is a strong correlation between structural and functional tests and vessel density values. The lower vascular density in the PEG group compared to the POAG group indicates that vascular damage may be more common in PEG patients.

Quantitative analysis of exosomes in the aqueous humor of Korean patients with pseudoexfoliation glaucoma

We aimed to quantitatively analyze the exosome and its cargo in individual aqueous humor (AH) samples from pseudoexfoliation (PEX) glaucoma patients compared to controls using a novel detection platform. We investigated the size distribution and measured the quantitative exosome particle counts in each AH sample. AH (80–120 µL) was obtained during cataract surgery or glaucoma filtering surgery from 12 Korean subjects (six with PEX glaucoma and six age-matched controls). The mean size of the exosomes was 58.9 ± 18.5 nm measured by a tangential flow filtration system using single-particle interferometric reflectance imaging sensor. Exosome particle count in each CD 63, CD 81, and CD9 spot was significantly greater in PEX glaucoma than in controls in total, CD 63, CD9, syntenin, and scattering(all p < 0.003). The CD63 spot showed a particle count of 8319.1 ± 797.7 in PEX glaucoma patients and 4786.8 ± 1302.1 in controls (p = 1.88E−11). Individual fluorescent capture spot images also revealed denser exosome particles in PEX patients than in controls. Syntenin, indicating exosomal origin, was detected in all AH samples. Exosomes differentially detected in AH suggest the possible role of exosomes in the pathogenesis of PEX glaucoma.

Evaluation of ABCA1 and FNDC3B Gene Polymorphisms Associated With Pseudoexfoliation Glaucoma and Primary Angle-Closure Glaucoma in a Saudi Cohort.

Objective: It is plausible that common disease mechanisms exist in glaucoma pathophysiology. Accordingly, we investigated the genetic association of two previously reported primary open-angle glaucoma (POAG)-related gene polymorphisms, rs2472493 (A > G) in ABCA1 and rs7636836 (C > T) in FNDC3B, in primary angle-closure glaucoma (PACG) and pseudoexfoliation glaucoma (PXG). Methods: TaqMan genotyping was performed in a total of 442 subjects consisting of 246 healthy controls, 102 PACG patients, and 94 PXG patients. Statistical evaluations were performed to detect allelic and genotype association of the variants with the disease and clinical variables such as intraocular pressure (IOP) and cup/disc ratio. Results: Overall, there was no allelic or genotype association of these variants in PACG and PXG. However, rs7636836[T] allele significantly increased the risk of PXG among men (p = 0.029, odds ratio [OR] = 2.69, 95% confidence interval = 1.11–6.51). Similarly, rs2472493 and rs7636836 genotypes also showed significant association with PXG among men in over-dominant model (p = 0.031, OR = 1.98, 95% CI = 1.06–3.71) and co-dominant model (p = 0.029, OR = 2.69, 95% CI = 1.11–6.51), respectively. However, none survived Bonferroni’s correction. Besides, the synergic presence of rs2472493[G] and rs7636836[T] alleles (G-T) was found to significantly increase the risk of PACG (p = 0.026, OR = 2.85, 95% CI = 1.09–7.46). No significant genotype influence was observed on IOP and cup/disc ratio. Conclusion: Our results suggest that the polymorphisms rs2472493 in ABCA1 and rs7636836 in FNDC3B genes may be associated with PXG among men, and a G-T allelic combination may confer an increased risk of PACG in the middle-eastern Saudi cohort. Further research in a larger population-based sample is needed to validate these findings.

Canaloplasty in Pseudoexfoliation Glaucoma. Can It Still Be Considered a Good Choice?

Purpose: The aim of this study was to assess the long-term outcomes of canaloplasty surgery in pseudoexfoliation glaucoma (PEXG) patients. Material and Methods: A total of 116 PEXG patients with an intraocular pressure (IOP) > 21 mm/Hg and maximum tolerated local medical therapy who underwent canaloplasty from February 2008 to January 2022 were considered. Every six months, all subjects underwent a complete ophthalmic examination. The period of follow-up ranged from 2 to 167 months. Inclusion criteria included only patients for whom the entire procedure could be completed with a follow-up of at least 2 years. Results: Amongst the 116 PEXG patients, the entire procedure could not be performed in 10 eyes (8.6%), and thus they were not considered in the analysis. Twenty-three patients did not reach the two-year follow-up and another 16 patients during this time period were lost. A total of 67 patients with a mean follow-up of 49 ± 32.3 months were considered in the analysis. The pre-operative mean IOP was 31.2 ± 8.7 mm/Hg (range 20–60). The mean IOP at the two-year follow-up was 17.2 ± 6.7 mmHg, with a mean reduction from baseline of 44.9%. After two years, the qualified success rates according to three different criteria (IOP ≤ 21, ≤18 and ≤16 mmHg) were 80.6%, 73.1% and 61.0%, respectively. The total number of medications used pre- and at the follow-up at 2 years was 3.5 ± 0.8 and 1.2 ± 1.4, respectively. Early complications included: hyphema, in about 30% of cases; Descemet membrane detachment (4.9%); and IOP spikes > 10 mmHg (9.7%). A late failure with an acute IOP rise of up to 50 mmHg was observed in 41 cases (61.2%) after 3 to 72 months. Conclusions: Long-term post-operative outcomes of canaloplasty in PEXG patients appear to be quite good on average; however, an acute rise in IOP can be observed in more than 60% of the cases after a long period of satisfactory IOP control. For this reason, canaloplasty may not be suitable in eyes with PEXG, especially in patients with severe functional damage.

Ultrastructural analysis of explanted CyPass microstents and correlation with clinical findings

PurposeThe purpose of this study was to obtain insight into cellular processes after CyPass microstent implantation into the supraciliary space. With this knowledge, we expected to find some reason for surgical failure.MethodsNine CyPass microstents of 8 patients with primary open-angle glaucoma (n = 1), pseudoexfoliation glaucoma (n = 5), uveitic glaucoma (n = 1), and posttraumatic open-angle glaucoma (n = 1) were explanted due to recurrence of IOP elevation, corneal decompensation, or persistent hypotony. The explants were processed for light and transmission electron microscopy.ResultsFibrotic material, consisting of collagen fibrils, microfibrils, pseudoexfoliation fibrils produced by activated fibroblasts, was detected in the stent lumen of 4/5 pseudoexfoliation glaucoma patients and also in posttraumatic open-angle glaucoma. Fibrotic material was also present on the outer surface and within fenestrations of the majority of stents. Complete absence of fibrotic reaction was noticed in 3 of 9 microstents.ConclusionAlthough MIGS is known to be less invasive than conventional surgery, implants placed in the suprachoroidal space may be adversely affected by a fibrotic tissue reaction resulting in implant failure. Understanding mechanisms and risk factors leading to fibrotic scarring following antiglaucomatous surgery may help to develop novel strategies that improve surgical outcome.

Comparison of long-term results of trabeculectomy and phacotrabeculectomy in patients with pseudoexfoliation glaucoma and primary open-angle glaucoma: a single-center study.

To evaluate long-term surgical success and complications in pseudoexfoliation glaucoma (PEXG) and primary open-angle glaucoma (POAG) after trabeculectomy or phacotrabeculectomy. 96 PEXG eyes and 114 POAG eyes who underwent primary trabeculectomy and phacotrabeculectomy were retrospectively evaluated considering intraocular pressure (IOP), the number of glaucoma medications, surgical success, and rate of complications. Two success criteria were used: Complete success comprised IOP of 5-18mmHg and 20% reduction of baseline IOP without medication. Qualified success comprised IOP of 5-18mmHg and 20% reduction of baseline IOP irrespective of medication. Success rates in PEXG and POAG groups, trabeculectomy and phacotrabeculectomy groups, and four groups divided according to surgery and etiology were analyzed via Kaplan-Meier survival analysis. The complete and qualified success were not different between PEXG and POAG groups. The qualified success curves show a similar pattern among the four groups throughout the follow-up of 1,2,3,5,7 and 9years. Baseline IOP and the number of medications were similar in all four groups (p = 0.275 and p = 0.209, respectively). IOP levels and the number of medications were not statistically different between the four groups during the follow-up of 2,5 and 7years. The total number of complications and interventions were similar between PEXG and POAG groups (p = 0.258). Phacotrabeculectomy is an effective procedure as trabeculectomy with similar surgical success rates and few surgical complications when it comes to treating PAOG and PEXG patients. Both approaches resulted in similar postoperative IOP levels and medication numbers in both groups.

Upregulated NOTCH Signaling in the Lens of Patients With Pseudoexfoliation Syndrome Compared With Pseudoexfoliation Glaucoma Suggests Protective Role.

NOTCH signaling is significantly upregulated in the lens capsules of eyes with pseudoexfoliation syndrome (PXF) but not in those with pseudoexfoliation glaucoma (PXG) when compared with healthy controls. NOTCH signaling has neuroprotective functions and altered NOTCH signaling is associated with neurodegenerative diseases with protein aggregation such as Alzheimer disease. As PXG is also a protein aggregate disease associated with neural degeneration, NOTCH molecular expression was explored in the lens capsules of patients with PXF, PXG, primary open-angle glaucoma (POAG), and healthy controls. Anterior lens capsules were collected from 106 patients (27 PXF, 24 PXG, 22 POAG, and 33 controls) undergoing cataract surgery. Gene expression profiling for NOTCH pathway molecules (ligands, receptors, and downstream target genes) was performed on the tissue using a quantitative reverse transcription-polymerase chain reaction. The results were confirmed by protein analysis using dot-blot or immunostaining techniques. There was no difference in the demographic characteristics between the groups. There was an increase in NOTCH4 receptor expression (>14-fold) in the PXF group as compared with the controls. Similarly, the Delta-like 3 and Delta-like 4 ligands were significantly elevated in the PXF group compared with controls (P<0.05). Downstream targets HES3, HES5, and HEY1 expression were significantly elevated (P<0.005) in PXF lens capsules, confirming a higher activity of NOTCH signaling in this cohort. Immunostaining also corroborated the gene expression profile. The finding that NOTCH signaling is significantly upregulated in the lens capsule of eyes with PXF and not in PXG or POAG patients suggests a possible protective role in the development of glaucoma.