Risk Factor For Development Of Glaucoma Research Articles

Evaluating Intraocular Pressure Alterations during Large Muscle Group Isometric Exercises with Varying Head and Body Positions.

Performing physical exercise affects intraocular pressure, and its elevation and fluctuations are the main risk factors for glaucoma development or progression. The aim of this study was to examine the acute alterations in intraocular pressure (IOP) during four unweighted isometric exercises and to determine whether the different head and body positions taken during exercise additionally affect IOP. Twelve healthy volunteers between the ages of 25 and 33 performed four isometric exercises: wall sit in neutral head and body position, elbow plank in prone head and body position, reverse plank in supine head and body position for 1 min, and right-side plank in lateral head and body position for 30 s. Intraocular pressure was measured by applanation portable tonometry, before performing the exercise, immediately after exercise completion, and after five minutes of rest. A significant acute increase in intraocular pressure was found as a response to the performance of the elbow plank (p < 0.01), the reverse plank (p < 0.001), and the right-side plank (p < 0.001). The wall sit exercise did not reveal a statistically significant IOP elevation (p = 0.232). Different head and body positions had no significant additional influence on IOP (F (3,33) = 0.611; p = 0.613), even though the alteration in IOP was found to be greater in exercises with a lower head and body position. Our data revealed that IOP elevation seems to be affected by the performance of the elbow plank, the reverse plank, and the right-side plank; and not by the wall sit exercise. More different isometric exercises should be examined to find ones that are safe to perform for glaucoma patients.

Real-time in vivo monitoring of intraocular pressure distribution in the anterior chamber and vitreous chamber for diagnosis of glaucoma.

Glaucoma causes irreversible vision loss due to optic nerve damage and retinal cell degeneration. Since high intraocular pressure (IOP) is a major risk factor for glaucoma development, accurate IOP measurement is crucial, especially intravitreal IOP affecting the optical nerve and cells. However, conventional methods have limits in selectively and directly detecting local retina pressure. Here, we present continuous measurements of local IOP values in the anterior chamber and vitreous chamber of living animals using minimally invasive probes with pressure-sensitive transistors. After inducing glaucoma in animal models, we compared the local IOP distribution between normal and glaucomatous eyes. We also compared IOP values detected in the cornea using tonometry measurements. Our findings revealed that glaucoma induced higher IOP in the vitreous chamber than in the anterior chamber, indicating that measuring IOP in the vitreous chamber is key to the glaucoma model. This progress offers future directions for diagnosis and treatment of glaucoma.

Immunomodulatory and Antioxidant Drugs in Glaucoma Treatment.

Glaucoma, a group of diseases characterized by progressive retinal ganglion cell loss, cupping of the optic disc, and a typical pattern of visual field defects, is a leading cause of severe visual impairment and blindness worldwide. Elevated intraocular pressure (IOP) is the leading risk factor for glaucoma development. However, glaucoma can also develop at normal pressure levels. An increased susceptibility of retinal ganglion cells to IOP, systemic vascular dysregulation, endothelial dysfunction, and autoimmune imbalances have been suggested as playing a role in the pathophysiology of normal-tension glaucoma. Since inflammation and oxidative stress play a role in all forms of glaucoma, the goal of this review article is to present an overview of the inflammatory and pro-oxidant mechanisms in the pathophysiology of glaucoma and to discuss immunomodulatory and antioxidant treatment approaches.

Clinical and genetic aspects of glaucoma associated with congenital aniridia

Congenital aniridia is a hereditary congenital malformation of the visual organ with an autosomal dominant type of inheritance. The prognosis for vision largely depends on the development and progression of multiple complications (glaucoma, keratopathy, and aniridia fibrotic syndrome) at different ages.&#x0D; AIM: To identify the most significant risk factors for glaucoma development and a poor prognosis associated with congenital aniridia.&#x0D; MATERIAL AND METHODS: Seventy-three children (146 eyes) with PAX6-associated aniridia aged 016 yr were examined, with 41 males (56.2%) and 32 females (43.8%). The follow-up period of patients ranged from 2 to 6 yr. Thirty-five (47.9%) patients had complete aniridia, and 38 (52.1%) patients had partial aniridia. All patients underwent a comprehensive ophthalmological and molecular genetic examination.&#x0D; RESULTS: Glaucoma developed in 28.8% of children. Anomalies in the anterior chamber angle (ACA) structure were detected in most patients with congenital aniridia, both with and without glaucoma. However, the relationship between the ACA and the timing of the manifestation of glaucoma was revealed. Furthermore, according to our study, the presence of glaucoma increases the risk of keratopathy progression.&#x0D; CONCLUSION: In a molecular genetic study, the presence of deletions in the 3'-cis-regulatory region of the PAX6 gene was a predictor of glaucoma development.

Natural History of Optic Disc With Physiologic Large Cup: Incidence, Predictors of Glaucoma Conversion After Minimum 10-Year Follow-up

To investigate the natural history of optic disc with physiologic large cup (PLC) (ie, vertical cup/disc ratio [VCDR] ≥0.6 without retinal nerve fiber layer defect) and the risk factors for glaucoma conversion. Observational retrospective cohort study. Subjects who underwent a health screening examination at Seoul National University Hospital Healthcare System Gangnam Center from 2003 to 2010 (n=76,030) were involved. The prevalence of PLC in the cohort was analyzed. The incidence rate of glaucoma conversion was estimated per 100 person-years among cases with a follow-up period longer than 10 years. Multivariate Cox proportional hazards regression was used to identify ocular and systemic factors associated with glaucoma conversion. Among 74,617 eligible subjects, 3569 subjects (4.8%) had PLC. Of those with a follow-up period longer than 10 years (n=859), the incidence rate of glaucoma conversion was 0.95 per 100 person-years. A total of 12.1% of PLC eyes progressed to glaucoma after 8.7 ± 3.9 years (range, 2.0-16.5 years). Higher VCDR (adjusted hazard ratio [aHR]=4.36; 95% CI=2.675-7.103), violation of the inferior superior nasal temporal neuroretinal rim thickness rule (aHR=1.86; 95% CI=1.057-3.258), presence of retinal arterial sclerosis (aHR=1.63; 95% CI=1.040-2.550), and lower total bilirubin level (aHR=0.58; 95% CI=0.340-0.991) were associated with glaucoma development. This study identified the prevalence of PLC as well as the incidence rate of glaucoma conversion and the risk factors for glaucoma development in PLC eyes. The natural history of PLC may help clinicians to better understand its risk factors and the specific management needs of their patients.

Meldonium Inhibits Cell Motility and Wound-Healing in Trabecular Meshwork Cells and Scleral Fibroblasts: Possible Applications in Glaucoma.

Meldonium (MID) is a synthetic drug designed to decrease the availability of L-carnitine-a main player in mitochondrial energy generation-thus modulating the cell pathways of energy metabolism. Its clinical effects are mostly evident in blood vessels during ischemic events, when the hyperproduction of endogenous carnitine enhances cell metabolic activities, leading to increased oxidative stress and apoptosis. MID has shown vaso-protective effects in model systems of endothelial dysfunction induced by high glucose or by hypertension. By stimulating the endothelial nitric oxide synthetase (eNOS) via PI3 and Akt kinase, it has shown beneficial effects on the microcirculation and blood perfusion. Elevated intraocular pressure (IOP) and endothelial dysfunction are major risk factors for glaucoma development and progression, and IOP remains the main target for its pharmacological treatment. IOP is maintained through the filtration efficiency of the trabecular meshwork (TM), a porous tissue derived from the neuroectoderm. Therefore, given the effects of MID on blood vessels and endothelial cells, we investigated the effects of the topical instillation of MID eye drops on the IOP of normotensive rats and on the cell metabolism and motility of human TM cells in vitro. Results show a significant dose-dependent decrease in the IOP upon topic treatment and a decrease in TM cell motility in the wound-healing assay, correlating with an enhanced expression of vinculin localized in focal adhesion plaques. Motility inhibition was also evident on scleral fibroblasts in vitro. These results may encourage a further exploration of MID eye drops in glaucoma treatment.

Incidence and risk factors for glaucoma development and progression after corneal transplantation.

To assess the cumulative incidence and risk factors for glaucoma development and progression within 1-2 years following corneal transplant surgery. Retrospective cohort study. Patients undergoing penetrating keratoplasty (PK), deep anterior lamellar keratoplasty (DALK), Descemet stripping endothelial keratoplasty (DSEK), Descemet membrane endothelial keratoplasty (DMEK), Boston keratoprosthesis type I (KPro) implantation, or endothelial keratoplasty (DSEK or DMEK) under previous PK (EK under previous PK) at one academic institution with at least 1 year of follow-up were included. Primary outcome measures were cumulative incidence of glaucoma development and progression after corneal transplant, in patients without and with preoperative glaucoma, respectively. Risk factors for glaucoma development and progression were also assessed. Four hundred and thirty-one eyes of 431 patients undergoing PK (113), DALK (17), DSEK (71), DMEK (168), KPro (35) and EK under previous PK (27) with a mean follow-up of 22.9 months were analyzed. The 1-year cumulative incidence for glaucoma development and progression was 28.0% and 17.8% in patients without and with preoperative glaucoma, respectively. In a Cox proportional hazards analysis, DSEK surgery, KPro implantation, average intraocular pressure (IOP) through follow-up and postoperative IOP spikes of ≥30 mmHg were each independently associated with glaucoma development or progression (p < 0.04 for all). A significant proportion of patients developed glaucoma or exhibited glaucoma progression within 1 year after corneal transplantation. Patient selection for DSEK may partly explain the higher risk for glaucoma in these patients. Postoperative IOP spikes should be minimized and may indicate the need for co-management with a glaucoma specialist.

Time of Peak Intraocular Pressure during Water Drinking Test and Modified Phasing Among Glaucoma Patients in South-East Nigeria

Background: High intraocular pressure (IOP) peaks and fluctuations which are among the significant risk factors for glaucoma development and progression can be detected through water drinking test (WDT) and phasing. Aim: To determine the time of peak IOP during WDT and modified phasing among primary open angle glaucoma (POAG) patients on medical treatment at Enugu State University of Science and Technology Teaching Hospital Parklane (ESUTTHP), Enugu. Methodology: The study was a hospital based cross sectional study on POAG patients on medical treatment attending the eye clinic of ESUTTHP, Enugu. One hundred and thirty patients were selected by simple random sampling. Their eyes were examined which included visual acuity assessment, follow-up clinic intraocular pressure measurement, gonioscopy, anterior and posterior segments examination. WDT and modified phasing were carried out on them. WDT was done over 2 hours after intake of 1 liter of water with intraocular pressure measured every 15 minutes. Modified phasing was done over 8 hours with intraocular pressure measured at 2 hourly intervals. Data analysis was done using SPSS version 20 (U.S.A). Results: A total of 130 POAG patients (260 eyes) on medical treatment were examined comprising of 56 males (43.1%) and 74 females (56.9%). Their age ranged between 42 and 83 years with mean age of 62.25 ± 9.002. The peak IOP occurred in 90.2% of patients within the first 1 hour of water drinking test with 23.6% of the eyes having peak IOP at 15 minutes, 24.0% at 30 minutes, 22.9% at 45 minutes, 20.2% of eyes at 60 minutes, 6.6% of eyes at 75 minutes, 2.3% at 90 minutes, 0.0% at 105 minutes and 0.4% at 120 minutes. The peak IOP occurred in two-thirds (74.1%) of eyes within the first 4 hours of commencing modified phasing while 25.8% had their IOP peak after 4 hours with 30.6% of the eyes having peak IOP at onset of the test, 28.2% at 2 hours, 15.3% at 4 hours, 16.1% at 6 hours and 9.7% at 8 hours. Conclusion: WDT may be done over 1 hour instead of 2 hours as a quick clinic test to detect IOP peaks among glaucoma patients on treatment. Some POAG patients also have IOP peaks occurring in the afternoon during modified phasing and such peaks should not be missed in those patient’s management.

Technological advances in ocular trabecular meshwork in vitro models for glaucoma research.

Glaucoma is the leading cause of irreversible blindness worldwide and is characterized by the progressive degeneration of the optic nerve. Intraocular pressure (IOP), which is considered to be the main risk factor for glaucoma development, builds up in response to the resistance (resistance to what?) provided by the trabecular meshwork (TM) to aqueous humor (AH) outflow. Although the TM and its relationship to AH outflow have remained at the forefront of scientific interest, researchers remain uncertain regarding which mechanisms drive the deterioration of the TM. Current tissue‐engineering fabrication techniques have come up with promising approaches to successfully recreate the TM. Nonetheless, more accurate models are needed to understand the factors that make glaucoma arise. In this review, we provide a chronological evaluation of the technological milestones that have taken place in the field of glaucoma research, and we conduct a comprehensive comparison of available TM fabrication technologies. Additionally, we also discuss AH perfusion platforms, since they are essential for the validation of these scaffolds, as well as pressure–outflow relationship studies and the discovery of new IOP‐reduction therapies.

Green tea-a new perspective of glaucoma prevention.

To determine how green tea and catechins can affect intraocular pressure (IOP) changes. Totally 43 young volunteers were included in the study. The experiment was held between noon and 2 p.m. Two extracts-green tea and epigallocatechin gallate (EGCG, 400 mg capsules) and placebo (400 mg capsules) were used in the study. Participants were divided into three groups. Green tea extract group (GT group) had 17 subjects, EGCG extract group 17 subjects, control (placebo) group 9 subjects. IOP was measured with the Icare tonometer before and 30min, 1, 1.5, 2h after the consumption of each extract and placebo. Results were analyzed using the IBM SPSS program. Statistical confidence level P<0.05. The most significant reduction of IOP from the beginning of the experiment was measured after 2h in GT group (left 2.18±3.19 mm Hg, P=0.012; right 2.59±1.97 mm Hg, P<0.000) and after 1h in EGCG extract group (left 2.41±2.98 mm Hg, P<0.004; right 1.94±1.98 mm Hg, P<0.001). In control group no significant changes were measured. People who have increased IOP or risk factors for glaucoma development, could benefit from drinking green tea or its concentrated extracts in moderate doses.

Corneal hysteresis: ready for prime time?

This review summarizes recent findings on corneal hysteresis, a biomechanical property of the cornea. Corneal hysteresis measurements can be easily acquired clinically and may serve as surrogate markers for biomechanical properties of tissues in the back of the eye, like the lamina cribrosa and peripapillary sclera, which may be related to the susceptibility to glaucomatous damage. Several studies have provided evidence of the associations between corneal hysteresis and clinically relevant outcomes in glaucoma. Corneal hysteresis has been shown to be predictive of glaucoma development in eyes suspected of having the disease. For eyes already diagnosed with glaucoma, lower corneal hysteresis has been associated with higher risk of progression and faster rates of visual field loss over time. Such associations appear to be stronger than those for corneal thickness, suggesting that corneal hysteresis may be a more important predictive factor. Recent evidence has also shown that cornealcorrected intraocular pressure measurements may present advantages compared to conventional Goldmann tonometry in predicting clinically relevant outcomes in glaucoma. Given the evidence supporting corneal hysteresis as an important risk factor for glaucoma development and its progression, practitioners should consider measuring corneal hysteresis in all patients at risk for glaucoma, as well as in those already diagnosed with the disease.

Elevated Hydrostatic Pressure Causes Retinal Degeneration Through Upregulating Lipocalin-2.

Elevation of intraocular pressure is a major risk factor for glaucoma development, which causes the loss of retinal ganglion cells (RGCs). Lipocalin 2 (Lcn2) is upregulated in glaucomatous retinae; however, whether Lcn2 is directly involved in glaucoma is debated. In this study, retinal explant cultures were subjected to increased water pressure using a two-chamber culture device, and Lcn2 protein levels were examined by immunoblotting. In situ TdT-mediated dUTP nick and labeling (TUNEL) and glial fibrillary acidic protein (GFAP) immunohistochemical assays were performed to assess apoptosis and gliosis, respectively. The neurotoxicity of Lcn2 in the retinal explant culture was determined with exogenous administration of recombinant Lcn2. The Lcn2 protein levels, percentage of TUNEL-positive cells, and GFAP-positive area were significantly higher in retinae cultured under 50 cm H2O pressure loads compared to those cultured under 20 cm H2O. We found that Lcn2 exhibited neurotoxicity in retinae at dose of 1 μg/ml. The negative effects of increased hydrostatic pressure were attenuated by the iron chelator deferoxamine. This is the first report demonstrating the direct upregulation of Lcn2 by elevating hydrostatic pressure. Modulating Lcn2 and iron levels may be a promising therapeutic approach for retinal degeneration.

Effect of Different Body Positions on Intraocular Pressure in Patients with Primary Open Angle Glaucoma

Background: Primary open-angle glaucoma (POAG) is the most common type of glaucoma. Increasing age, elevated intraocular pressure (IOP), and a positive family history are risk factors for POAG incidence. Elevated IOP is a major risk factor for glaucoma development and progression. The mechanism for IOP changes with body position is not completely understood. Objective: The present study was aimed to investigate the effects of different body positions on IOP in patients with primary open-angle glaucoma. Patients and methods: This prospective study included a total of 60 glaucoma and glaucoma suspect patients and 30 normal subjects, attending at Aswan University Hospital. Subjects were divided into 3 groups (normal, glaucoma suspect and primary open angle glaucoma). Each subject underwent thorough ophthalmological evaluation including best corrected visual acuity, slit lamp biomicroscopy, tonometry, gonioscopy, and dilated fundus evaluation. The Perkin's tonometer was used to measure IOP in different sleeping positions (at zero o degree, at 30o degree and 45o) positions. In all these positions, baseline IOP as well as after 30 minutes IOP was measured. Results: Comparison of both age and gender across different groups showed that there were no statistically significant differences among them. In terms of the IOP, comparing all of the three groups at baseline showed that there was a statistically significant difference across groups (p < 0.0001). There was a statistically significant reduction of IOP in 30 and 45 degree semi sitting positions compared to supine positions in all study groups. Conclusion: It could be concluded that certain sleeping positions appear to be associated with changes in intraocular pressure. It is essential not to overlook these short term fluctuations particularly in patients with primary open angle glaucoma as they can affect progression of the disease.

New solutions for old challenges in glaucoma treatment: is taurine an option to consider?

Glaucoma is a range of progressive optic neuropathies characterized by progressive retinal ganglion cell loss and visual field defects. It is recognized as a leading cause of irreversible blindness affecting more than 70 million people worldwide. Currently, reduction of intraocular pressure, a widely recognized risk factor for glaucoma development, is the only pharmacological strategy for slowing down retinal ganglion cell loss and disease progression. However, retinal ganglion cell death and visual field loss have been observed in normotensive glaucoma, suggesting that the disease process is partially independent of intraocular pressure. Taurine is one of the agents that have attracted attention of researchers recently. Taurine has been shown to be involved in multiple cellular functions, including a central role as a neurotransmitter, as a trophic factor in the central nervous system development, as an osmolyte, as a neuromodulator, and as a neuroprotectant. It also plays a role in the maintenance of the structural integrity of the membranes and in the regulation of calcium transport and homeostasis. Taurine is known to prevent N-methyl-D-aspartic acid-induced excitotoxic injury to retinal ganglion cells. A recently published study clearly demonstrated that taurine prevents retinal neuronal apoptosis both in vivo and in vitro. Protective effect of taurine may be attributed to direct inhibition of apoptosis, an activation of brain derived neurotrophic factor-related neuroprotective mechanisms and reduction of retinal oxidative and nitrosative stresses. Further studies are needed to fully explore the potential of taurine as a neuroprotective agent, so that it can be applied in clinical practice, particularly for the treatment of glaucoma. The objective of current review was to summarize recent evidence on neuroprotective properties of taurine in glaucoma.

Incidence and Risk Factors of Glaucoma Following Pediatric Cataract Surgery With Primary Implantation

To determine the incidence and risk factors for glaucoma after pediatric cataract surgery with intraocular lens (IOL) implantation. Retrospective, consecutive case series. In this single-center study, we reviewed 136 children (199 eyes) who underwent pediatric cataract surgery before 1 year of age with a minimum of 1 year of follow-up. The intervention used was pediatric cataract surgery with IOL implantation, and the primary outcome measure was the presence or absence of secondary glaucoma. The mean age at surgery was 148 ± 93days (range 30-359days) with a mean follow-up of 6.3 ± 3.6 years (range 1.1-12.8 years). Glaucoma developed in 31 eyes (16%) with 5- and 10-year incidence rates of 12% and 28%, respectively. The incidence of glaucoma seemed to be bimodal, with a first peak occurring after a mean delay of 2.5months (range 1.6-4.1months) and a second peak occurring after a mean delay of 5.7 years (range 2.6-11.7 years). Younger age at surgery, shorter axial length, longer follow-up, use of trypan blue, reintervention, and bilateral surgery were associatied with a higher incidence of glaucoma. Multivariate analysis including the aforementioned variables indentified longer follow-up (odds ratio [OR]= 1.3 [95% confidence interval {CI} 1.1-1.6], P= .001), reintervention (OR= 4.1 [95% CI 1.2-13.4], P= 0.02), and the use of trypan blue (OR= 4.1 [95% CI 1.3-13.1], P= .02) as predictors for the development of glaucoma. Glaucoma is a common complication after pediatric cataract surgery. It seemed to have a bimodal incidence. Risk factors for glaucoma development were reintervention, the use of trypan blue, and a long follow-up.

Ocular Perfusion Pressure and the Risk of Open-Angle Glaucoma: Systematic Review and Meta-analysis

Low ocular perfusion pressure (OPP) has been proposed as an important risk factor for glaucoma development and progression, but controversy still exists between studies. Therefore, we conducted a systematic review and meta-analysis to analyze the association between OPP and open-angle glaucoma (OAG). Studies were identified by searching PubMed and EMBASE databases. The pooled absolute and standardised mean difference in OPP between OAG patients and controls were evaluated using the random-effects model. Meta-regression analysis was conducted to investigate the factors associated with OPP difference between OAG patients and controls. A total of 43 studies were identified including 3,009 OAG patients, 369 patients with ocular hypertension, and 29,502 controls. The pooled absolute mean difference in OPP between OAG patients and controls was −2.52 mmHg (95% CI −4.06 to −0.98), meaning significantly lower OPP in OAG patients (P = 0.001). Subgroup analyses showed that OAG patients with baseline IOP > 21 mmHg (P = 0.019) and ocular hypertension patients also had significantly lower OPP than controls (P < 0.001), but such difference in OPP was not significant between OAG patients with baseline IOP of ≤21 mmHg and controls (P = 0.996). In conclusion, although no causal relationship was proven in the present study, our findings suggest that in patients with high baseline IOP, who already have a higher risk of glaucoma, low OPP might be another risk factor.

Dependency of intraocular pressure on body posture in glaucoma patients : New approaches to pathogenesis and treatment

Human intraocular pressure (IOP) depends on the position of the head in relation to the body in space. Physiologically, the IOP increases in alying position compared to an upright posture. Microgravity in space also appears to cause an increase in intraocular pressure, accompanied by other ophthalmological changes, which are summarized under the term spaceflight associated neuro-ocular syndrome (SANS). Bed rest studies are being carried out to investigate the effects of weightlessness on the human body. So here there is an intersection between research into SANS and glaucoma. Increased intraocular pressure remains the most important risk factor for glaucoma development and progression that can be influenced by treatment. The influence of position-dependent IOP fluctuations on glaucoma is still not sufficiently understood. A literature search was carried in PubMed on the subject of IOP fluctuations related to posture. Analysis and evaluation of the published study results and a summary of available clinical data. The increase in IOP when changing from aseated to alying body position is greater in glaucoma patients with an increase of up to 8.6 mm Hg compared to healthy subjects with an increase up to 5 mm Hg. In small pilot studies the increase in lying IOP in some glaucoma patients and healthy volunteers could be attenuated by elevation of the head by 30%. Alower compartmental pressure in the subarachnoid space has been associated with glaucoma and may represent arisk factor for glaucoma development. Not only the level of IOP but also IOP fluctuations were associated with an increased risk of disease progression. The clinical significance of IOP peaks during sleep on glaucoma is still not sufficiently understood. New methods for continuous IOP measurement offer promising opportunities for further research into the importance of IOP fluctuations related to changes of body and head posture.

Терапия системных заболеваний как фактор риска развития и прогрессирования глаукомы

The prevalence of multimorbidity defined as the presence of two or more chronic diseases increases with ageing. Multimorbidity which is associated with a decline in the quality of life and functional abilities results in the increase in the rate of various physiological disorders and hospital treatment and, therefore, growing healthcare costs. Glaucoma treatment, in particular, in elderly patients, is often accompanied by systemic comorbidities and the intake of multiple systemic drugs. Some systemic agents are known to affect the development of glaucoma (i.e., corticosteroids, some of cardiovascular drugs etc.). However, the data on the effect of systemic medications on the levels of intraocular pressure (IOP) and glaucoma progression remain controversial. Understanding the mechanisms of the effects of systemic medications on IOP levels is of crucial importance. Hence, well-designed prospective randomized controlled studies are required to evaluate these effects. This review paper summarizes published data on the effects of common systemic drugs on IOP levels as well as the risks of the development and progression of primary open-angle glaucoma.Keywords: glaucoma, systemic medications, risk factors, comorbidity, polypharmacy.For citation: Getmanova A.M., Brezhnev A.Yu., Kuroyedov A.V. et al. Systemic therapy a risk factor for glaucoma development and progression. Russian Journal of Clinical Ophthalmology. 2020;20(4):191–196. DOI: 10.32364/2311-7729-2020-20-4-191-196.

Incidence and Risk Factors for Glaucoma Development After Bilateral Congenital Cataract Surgery in Microphthalmic Eyes

To evaluate the long-term incidence and risk of glaucoma after bilateral congenital cataract surgery in microphthalmic eyes. Retrospective, observational case series. Subjects: Children with microphthalmic eyes who had undergone surgery for bilateral congenital cataract within 6months of birth and been followed up for at least 5 years. Review of medical records at our institution. Probability of an eye's developing glaucoma after bilateral congenital cataract surgery and associated risk factors. Thirty-eight eyes of 19 children with bilateral congenital cataract were included. The mean age at surgery was 3.2 ± 1.7months, and the mean follow-up duration was 7.79 ± 2.61 years. After cataract surgery, 11 eyes (29.0%) developed glaucoma at the age of 4.0 ±1.4 years. Three of these eyes underwent Ahmed glaucoma valve implantation surgery. The probability of an eye's developing glaucoma was estimated to be 32.0% by 10 years after surgery. In a multivariate analysis, axial length was significantly associated with glaucoma development (odds ratio= 0.364, P= .025). Age at the time of cataract surgery, corneal diameter, and aphakia did not affect the risk of glaucoma (P > .10). Eyes without glaucoma had a better final visual outcome than those with glaucoma (0.75 ± 0.60 and 1.47 ± 1.10 logMAR, respectively, P= .049). The long-term cumulative risk of postoperative glaucoma development was 32.0% by 10 years after bilateral congenital cataract surgery. Because the risk of developing glaucoma persists for several years after surgery, careful monitoring and control of intraocular pressure is needed to preserve vision in such patients.

Long-term results of secondary intraocular lens implantation in children under 30 months of age

PurposeTo report the long-term outcome of early secondary intraocular lens (IOL) implantation following congenital cataract extraction in a large number of eyes.MethodsData of aphakic children under 30 months of age who underwent secondary IOL implantation and had at least one year of follow-up after the surgery was reviewed. In all of the patients, a foldable three-piece acrylic IOL was implanted in the ciliary sulcus by the same surgeon using the same technique. The database studied included refractive and visual acuity (VA) outcomes and complications.ResultsFifty patients (75 eyes) were included. The average age at the time of cataract extraction was 94.20 ± 44.94 days and 20.7 ± 6.0 months in the secondary IOL implantation. After 82.32 ± 48.91 months, the VA was 0.58 ± 0.35 LogMAR and the spherical equivalent was −2.20 ± 4.19 D. There was a negative correlation between a longer follow-up period and myopia at the SE measured (P = .001). The most frequent complications included glaucoma and corectopia. Performing the secondary IOL implantation ≤ 20 months of age was not a risk factor for glaucoma development (P = 0.095).ConclusionSecondary IOL implantation under 30 months of age is an option for children with unsatisfactory management of the optic treatment. A predictable IOL power calculation and satisfactory visual outcomes compared to results of later secondary IOL implantation are possible.