Types Of Glaucoma Research Articles

Glaucoma screening skills among general ophthalmologists - How general should it be?

To compare the glaucoma assessment skills among general ophthalmologists in their referral patients over 5 years. This was a retrospective auditing of the electronic medical record database. Details of consecutive new glaucoma patients seen in the glaucoma services of a tertiary eye care institute in 2013 and 2018 were collected. Details of each patient included the clinical presentation, baseline intra-ocular pressure (IOP), type and severity of glaucoma, referral details, gonioscopy, HVF (Humphrey visual field) data, and the number of medications. Statistical tests used were the Chi-square test and T test using SPSS version 22. Of 28,886 medical records screened, 211 and 568 new glaucoma patients were retrieved in 2013 and 2018, respectively. The patients presenting in 2018 were younger (58.1 ± 15.4 years) at presentation than in 2013 (65.6 ± 15.2 years), P < 0.01, and also had higher baseline IOP (IOP ≥40 mm Hg was found in 9.5% in 2018 versus 2.4% in 2013; P < 0.01). The percentage of eyes with presenting visual acuity worse than 20/400 or 20/600 was higher in the patients presenting in 2018 (22.2% vs. 15.1%; P = 0.03). Although primary glaucoma predominated in both periods, the number of eyes referred to as disc suspects showed an increase in 2018 (4.7% to 14.4%; P < 0.01). Among 195 and 517 referrals in 2013 and 2018, respectively, the documentation of clinical findings were dismally poor in both the groups in terms of absent gonioscopy (99% vs. 98.2%, P = 0.4), absent disc details (89.6% vs. 91%, P = 0.5), or absent visual field analysis (79.1% vs. 74.8%, P = 0.2). However, the missing IOP values were significantly better in the latter year (77.3% vs. 57.2%; P < 0.01). The increase in the number of new glaucoma patients and referrals did not show a corresponding improvement in documentation of findings except for IOP recording among general ophthalmologists. Hence, we need to re-emphasize the training of general ophthalmologists on basic glaucoma evaluation to improve their referral ability.

Impact of Systemic Comorbidities on Ocular Hypertension and Open-Angle Glaucoma, in a Population from Spain and Portugal.

Open-angle glaucoma (OAG), the most prevalent clinical type of glaucoma, is still the main cause of irreversible blindness worldwide. OAG is a neurodegenerative illness for which the most important risk factor is elevated intraocular pressure (IOP). Many questions remain unanswered about OAG, such as whether nutritional or toxic habits, other personal characteristics, and/or systemic diseases influence the course of glaucoma. As such, in this study, we performed a multicenter analytical, observational, case–control study of 412 participants of both sexes, aged 40–80 years, that were classified as having ocular hypertension (OHT) or OAG. Our primary endpoint was to investigate the relationship between specific lifestyle habits; anthropometric and endocrine–metabolic, cardiovascular, and respiratory events; and commonly used psychochemicals, with the presence of OHT or OAG in an ophthalmologic population from Spain and Portugal. Demographic, epidemiological, and ocular/systemic clinical data were recorded from all participants. Data were analyzed using the R Statistics v4.1.2 and RStudio v2021.09.1 programs. The mean age was 62 ± 15 years, with 67–80 years old comprising the largest subgroup sample of participants in both study groups. The central corneal thickness (ultrasound pachymetry)-adjusted IOP (Goldman tonometry) in each eye was 20.46 ± 2.35 and 20.1 ± 2.73 mmHg for the OHT individuals, and 15.8 ± 3.83 and 16.94 ± 3.86 mmHg for the OAG patients, with significant differences between groups (both p = 0.001). The highest prevalence of the surveyed characteristics in both groups was for overweight/obesity and daily coffee consumption, followed by psychochemical drug intake, migraine, and peripheral vasospasm. Our data show that overweight/obesity, migraine, asthma, and smoking are major risk factors for conversion from OHT to OAG in this Spanish and Portuguese population.

Impact of self-tonometry on glaucoma treatment decision.

The aim of this study was to examine the impact of self-tonometry on clinicians' decision in glaucoma treatment. Medical records of 133 patients who had performed self-tonometry using iCare® Home between January and December 2019 were retrospectively reviewed. Inclusion criteria were as follows: age over 18 years, all types of glaucoma, as well as ocular hypertension and glaucoma suspect, compliance with tonometer manufacturer's recommendations and monitoring over at least 2 days. The data consisted of age, gender, diagnosis, visual field index, rate of progression and type of treatment pre- and post-intraocular pressure (IOP) phasing. The following IOP measurements were used to calculate the mean and maximum IOP, and range over each day and consecutive days: Goldmann applanation tonometry (GAT) measurements from referral and training visits and iCare® Home measurements made by the trainers and the patients themselves. A total of 90 patients were included. Clinicians were satisfied with the actual treatment in 54.4% of the cases. There was a statistically significant difference between the clinicians' decision to maintain same treatment or to escalate therapy for all the mean and maximum IOPs measured on each single day and over a 2- or 3-day period (p< 0.002). Our results suggest that the presence of high IOP values obtained with self-tonometry supports an intensification of glaucoma treatment. Self-tonometry provides clinicians with an important complement for clinical decision-making, and under- or over-treatment may be avoided for the benefit of patients.

Diagnosis and treatment of angle-closure glaucoma

Glaucoma is a polyetiological disease, which is based on increased intraocular pressure, leading to impaired visual fields and pathology of the optic nerve. As a result of increased pressure, there is an increase in the hydrodynamic load on the optic disc, gradually leading to its atrophy. Progressive narrowing of visual fields is another classic sign of glaucoma. This disease is one of the main causes of vision loss and related disability of the population. There are three main forms of glaucoma: primary open-angle, primary closed-angle, and secondary glaucoma, which develops against the background of the existing pathology of the organs of vision (diabetic retinopathy, acute iridocyclitis, post-thrombotic oculopathy). Primary open-angle glaucoma is the most common form of the disease, usually affecting the elderly. Angle-closure glaucoma is less common, but it is more dangerous. This form of the disease is often observed against the background of existing hypermetropia. This type of primary glaucoma develops as a result of a violation of the outflow in the drainage system of the eye due to the occlusion of the internal scleral sinus. In this case, the anterior chamber is significantly reduced in size or even disappears, and the lens is close to the cornea. Angle-closure glaucoma is characterized by a paroxysmal course, rapid progression, and a less favorable prognosis. In some cases, an acute attack of angle-closure glaucoma requires immediate hospitalization with subsequent surgical intervention.

Determinants of late presentation of glaucoma in Hong Kong.

Glaucoma is the commonest cause of irreversible blindness worldwide. As it is typically asymptomatic until advanced, the risk of blindness from late presentation is higher than other eye diseases. This study aims to investigate the risk factors for late presentation of primary glaucoma patients. We undertook a hospital-based case-control study of a random sample of glaucoma patients from a hospital in Hong Kong. Structured questionnaires and existing information from the electronic patient record were used, and the odds of presenting late were analysed by logistic regression. Of 210 recruited participants, 83 (39.5%) presented with advanced glaucoma unilaterally or bilaterally. The mean age of participants was 61.1 ± 11.9 years, with 110 males (52.4%). Univariate analysis revealed that male sex and primary angle-closure glaucoma (PACG) have 3.06 (CI95:1.71-5.48; P < 0.001) and 2.47 (CI95:1.11-5.49; P = 0.03) times higher odds of late presentation, respectively. Multivariate analysis revealed late presenters were 3.54 (CI95:1.35-9.35; P = 0.01) times more likely to have PACG than primary open-angle glaucoma (POAG). Patients with elevated baseline intraocular pressure (IOP) also had 1.06 times higher odds of presenting with advanced glaucoma (CI95:1.02-1.11; P = 0.002). Linear regression revealed that PACG patients present with 7.12 mmHg higher IOP than POAG patients (CI95:4.23-10.0; P < 0.001). In conclusion, a high proportion of glaucoma patients present late in Hong Kong, with gender and type of glaucoma being significant determinants. Our study shows that PACG presents with higher IOP and, along with male gender, are more likely to have advanced disease than POAG.

A Review on Glaucoma Drainage Devices and its Complications.

Glaucoma is one of the leading causes of blindness in the world. It is an ocular disorder that may have multiple etiologies and which can present as optic neuropathy and increased intraocular pressure (IOP), but in some cases like normotensive glaucoma, the IOP may remain normal. Its gradually progressive nature makes it important for early diagnosis; although the loss of vision is slow, lost vision can't be restored. Glaucoma drainage implant surgeries are an increasingly popular option in recent days in complicated cases of glaucoma where the previous trabeculectomy had failed and medical management was not responsive. Glaucoma drainage devices (GDD) are of various designs; they are implanted according to the patient condition and surgeons' preference. There are complications after the implantation of a GDD like hypotony, endophthalmitis, migration of the plate, extrusion, erosion of the mucous membrane, etc. In the market, there are various drainage devices present, but some of them are frequently used and popular.In this article, we will discuss some most commonly used GDDs and their complications. Among these, four are the most popular: Molteno, Baerveldt, Krupin, and Ahmed. The failure rate of the GDD is low. In many studies, it has been noted that only half of the GDD remains functional after five years. Therefore, further studies are still being conducted to refine the biomaterials, techniques, and shape of the GDD. The technique of surgery is also very much crucial in the success of GDD implantation. The glaucoma type is an essential factor in deciding the treatment, and the outcome of the surgery also depends on it.

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.

Current systems and recent developments of subthreshold laser systems in glaucoma: a narrative review

Background and Objective: Subthreshold laser technologies and their applications in ophthalmology have greatly expanded in the past few decades. Initially used for retinal diseases such as central serous chorioretinopathy and diabetic macular edema, subthreshold lasers have recently shown efficacy in the treatment of various types of glaucoma. Our primary objectives are to review the clinical applications of subthreshold laser in the context of glaucoma treatment and discuss the mechanisms of different subthreshold laser techniques, including subthreshold selective laser trabeculoplasty (SSLT), micropulse laser trabeculoplasty (MLT), pattern-scanning laser trabeculoplasty (PSLT), titanium laser trabeculoplasty (TLT), and micropulse transscleral cyclophotocoagulation (MP-TSCPC).

Protocol for systematic review and network meta-analysis of comparative effectiveness of surgical interventions for primary congenital glaucoma

IntroductionPrimary congenital glaucoma (PCG), a type of childhood glaucoma, is primarily treated surgically to lower intraocular pressure (IOP). Failure to intervene could result in partial, or even total, blindness. Various...

A study of connective tissue metabolites in biological fluids of patients with various types of glaucoma

PURPOSE. To quantify the content of connective tissue metabolites reflecting the exchange of its main components in biological fluids in low tension glaucoma (LTG) and primary open-angle glaucoma (POAG), and to conduct a comparative analysis of the obtained data. METHODS. The studies were conducted in 33 patients with low tension glaucoma aged 51 to 80 years old (mean age 69 ± 10.4 years), 20 patients with POAG aged 53 to 80 years old (mean age 67 ± 10.1 years) and 15 clinically healthy volunteers aged 52 to 78 years old (mean age 68 ± 9.2 years). The protein components of the fibrous part of the connective tissue were analyzed for daily excretion of oxyproline in urine by the method involving para-Dimethylamin-obenzaldehyde modified by P.N. Sharaev. Serum glycosaminoglycans (GAG) were studied by analyzing carbohydrate components of connective tissue. The concentration of GAG in the blood serum was determined by the colorimetric method, using Dische's carbazole reaction. RESULTS. The amount of GAG in the blood serum of LTG patients was 3.26 ± 1.57 mmol/L, while in the control group consisting of clinically healthy volunteers — 2.92 ± 1.25 mmol/L. The differences were not statistically significant (p &gt; 0.1). The amount of daily excretion of oxyproline in the urine of LTG patients was 17.17 ± 8.64 mmol/day, and in the group of clinically healthy individuals — 13.96 ± 5.61 mmol/day. The differences were statistically significant (p &lt; 0.05). The amount of GAG in the blood serum of POAG patients was 3.97 ± 1.17 mmol/L. The differences in relation to LTG were statistically significant (p &lt; 0.05). The amount of daily excretion of oxyproline in the urine of POAG patients was 32.71 ± 19.79 mmol/day. The differences were statistically significant in relation to LTG (p &lt; 0.05). The amount of GAG and oxyproline in biological fluids tends to increase with the advancement of LTG and POAG. CONCLUSION. Destruction processes in the connective tissue do occur in LTG, but are less pronounced in comparison to POAG and more pronounced in comparison to healthy individuals. The indicator that most clearly reflects the activity of destructive processes in the connective tissue is the daily excretion of oxyproline in urine.

Ocular Hypotony after Glaucoma Surgery

Background: Postoperative hypotony is associated with choroidal effusion, suprachoroidal haemorrhage, aqueous misdirection syndrome (malignant glaucoma), choroidal folds and hypotony maculopathy, anterior chamber (AC) shallowness or loss and subsequent failure of the original filtration of procedure. This work aimed to study the causes, risk factors, adverse effects, and management plans of ocular hypotony after different glaucoma surgeries.&#x0D; Methods: This retrospective study was carried out on 205 eyes underwent glaucoma surgery with follow up for more than 3 months. Patients were divided into two groups: 30 cases were diagnosed with post-operative hypotony, 175 eyes were without hypotony. Patients were subjected to glaucoma diagnosis, type of glaucoma operation and recorded IOP for 3 months at least.&#x0D; Results: CPC, Visco-Trab, Phaco Visco-Trab Visco and express valve were significantly different between the two groups (P=0.049, P=0.012, P=0.043 and P&lt;0.001 respectively) and other types of operation were insignificantly different between the two groups. IOP was significantly decreased at first diagnosis of hypotony and at last follow up compared to before operation (P value &lt;0.001). IOP at last follow up was significantly increased compared to first diagnosis of hypotony (P value &lt;0.001). Criteria of hypotony eyes were insignificantly different between patients needed surgical intervention and no surgical intervention.&#x0D; Conclusions: Postoperative hypotony was most common in pseudo-exfoliative glaucoma cases compared to other glaucoma types. While the most type of glaucoma surgery that was associated with postoperative hypotony was viscocanalostomy combined with express shunt. The adverse effects reported in our study were choroidal effusion and hypotony maculopathy.

Foreign body reaction after CyPass® Micro-Stent implantation: a case series.

To retrospectively assess the histopathological particularities of explanted CyPass® Micro-Stent of patients with significant loss of endothelial cell density. This is a case series of fourteen eyes from eleven patients who underwent CyPass® Micro-Stent implantation due to mild to moderate glaucoma and who subsequently suffered from loss of endothelial cell density. Therefore, the explantation of the device was necessary. In addition to the retrospective evaluation of the intraocular pressure and the endothelial cell density at the time of implantation and explantation, every surgically removed implant was histologically examined and evaluated. Fourteen eyes of eleven patients were in total analysed. The patients-seven males and four females-had a mean age of 62.9years. The average time between CyPass implantation and explantation was 3.7years. Eight patients suffered from primary-open-angle glaucoma (POAG), while two patients had a pseudoexfoliation glaucoma (PXG) and one patient had low-pressure glaucoma. Ten of the patients were already pseudophakic before the CyPass implantation and four patients underwent previously glaucoma interventions. There was a significant reduction in the intraocular pressure from 18.57 ± 5.27mmHg at the time of implantation to 14.78 ± 3.32mmHg at the time of explantation (p = 0.037). The average endothelial cell density decreased from 1843.67 ± 421.81 to 932.92 ± 412.86/mm2 at the time of explantation (p < 0.01). The histological findings showed a fibrous obliteration of the CyPass accompanied by a chronic granulomatous inflammation with giant cell macrophages. Histologically, these findings were consistent with a foreign body granuloma. Implants made of polyimides such as the CyPass® Micro-Stent are considered to be biocompatible, but there is no guarantee not to be obliterated or encapsulated. This is the first case series that has detected a foreign body granuloma in multiple eyes after CyPass implantation. However, there is no connection with the type of glaucoma, the extent of previous operations or with the presence of a prolonged postoperative inflammatory reaction.

Short-term outcomes of micropulse transscleral laser therapy using the revised delivery probe in refractory glaucoma.

To evaluate the effectiveness of MicroPulse® transscleral laser therapy (MP-TLT) using both the original and revised MicroPulse P3® delivery probes in patients with refractory glaucoma. Retrospective study METHODS: We analyzed the data of patients with refractory glaucoma who underwent MP-TLT with the original and with the revised MicroPulse P3® Delivery Device from January 2018 to December 2020 at the University of Tokyo Hospital and who were followed up for 3 months. Patients' demographics, preoperative and postoperative intraocular pressure (IOP), medication scores, best-corrected visual acuity (BCVA), and complications were analyzed. This study enrolled 40 patients in both probe groups. At baseline, the mean IOP was 31.1 mmHg in the original group and 29.2 mmHg in the revised group, and it decreased to 22.6 mmHg and 21.6 mmHg after 3 months, respectively (paired t-test p=0.001, 0.001). No significant difference was noted between the number of medications and BCVA at baseline and 3 months in either probe group (paired t-test, p>0.05). Nor were any serious complications observed. MP-TLT using the revised MicroPulse P3® Delivery Device for the treatment of refractory glaucoma was effective in reducing IOP across glaucoma types with an excellent safety profile and was well-tolerated by the patients.

A clinical study of primary open angle glaucoma (POAG) in myopia-An observational study

The Primary open-angle glaucoma is the most common type of glaucoma causing irreversible blindness. Myopia is one of the risk factor responsible for pathogenesis of glaucoma. The association between myopia and primary open angle glaucoma has been found in numerous case studies. The aim of the study to evaluate the relationship of myopia in primary open-angle glaucoma by classifying the eyes into low, moderate and high myopia.This prospective study was performed on 1414 axial myopic patients more &amp;#62; 18 years. Clinical examination included, slit-lamp biomicriscopy, Goldman applanation tonometry, refraction, dilated optic disc assessment, central corneal thickness, visual field analysis and optical coherence tonography.Out of 1414 patients, 769(54.38%) were male and 645(45.62%) were female. Low myopia (&amp;#60;-3D) cases are 938(66.32%), moderate myopia (-3D to -D) 309(21.88%), high myopia (&amp;#62;-6D), 107(11.8%). Maximum number of cases were in younger age group (20-30 years). Intraoccular Pressure &amp;#62; 21mmHg in 143 cases of low myopia, 78 cases in moderate myopia, 72 cases in high myopia. There were 138 cases with glaucomatous field changes. Out of 138 cases 86(62.32%) were high myopia, 35(25.36%) were moderate myopia and 17(10.8%) cases were low myopia. The CUP-DISC ratio &amp;#60;0.5 in 75.95% cases, 0.5-&amp;#60;0.9 in 20.37% cases, &amp;#62;0.9 in 3.68% cases. The average values of circumpapilary Nerve Fiber Layer thickness in micrometer of low myopia, moderate myopia, high myopia, with non-glaucomatous cases were 98.9, 97.3, 93.5 and with glaucomatous cases, 74.4, 73.7 and 73.3 respectively. The average values of Ganglion Cell Complex thickness in micrometer in low, moderate and high myopia without glaucoma were 94.9, 93.5, 92.7 and with glaucoma 77.3, 74.6, 70.2 respectively. This study shows there is strong relationship between myopia and primary open-angle glaucoma. Early detection of glaucoma in myopic patients is necessary in delaying blindness.

Outcomes and risk factors for ab interno trabeculotomy with a Kahook Dual Blade.

To verify the surgical results and risk factors for ab interno trabeculotomy using a Kahook Dual Blade (KDB-LOT) in patients with various glaucoma types. This study was a retrospective case series of 205 eyes that underwent KDB-LOT. For Kaplan-Meier survival analysis, criterion A was defined as a ≤ 20% reduction in intraocular pressure (IOP) from baseline. Criteria B, C, and D were IOPs of ≤ 21, 18, and 15mmHg, respectively. The Cox proportional hazard (CPH) model investigated prognostic factors. The mean (SD) IOP decreased from 24.7 (7.98) to 17.6 (4.80) mmHg in all cases, from 21.3 (6.88) to 17.8 (3.52) mmHg in primary open-angle glaucoma (POAG), from 25.4 (7.32) to 17.1 (4.65) mmHg in exfoliation glaucoma, from 30.6 (8.88) to 17.8 (8.29) mmHg in uveitic glaucoma, and from 30.8 (7.29) to 17.3 (0.83) mmHg in steroid-induced glaucoma at 1year after KDB-LOT. The Kaplan-Meier survival analysis showed that patients with POAG had the best prognosis under criteria B and C, and the 1-year survival rate in patients under criterion D was less than 35% for any disease type. CPH analysis revealed that age and KDB-LOT with phacoemulsification were good prognostic factors. Risk factors for surgical failure were previous cataract surgery, selective laser trabeculoplasty, and postoperative peripheral anterior synechiae. KDB-LOT was effective in treating patients with several glaucoma types but showed difficulty in pushing IOP below 15mmHg. Prognostic factors should be considered when making decisions regarding surgical indications.

Selective Laser Trabeculoplasty and Outcomes of Subsequent Phacoemulsification Combined with Kahook Dual Blade Goniotomy.

IntroductionTo investigate the relationship between intraocular pressure (IOP)-lowering success of selective laser trabeculoplasty (SLT) and combined phacoemulsification/Kahook Dual Blade (phaco/KDB) goniotomy in eyes with mild to severe open angle glaucoma (OAG).MethodsEyes undergoing combined phaco/KDB goniotomy and that had previously undergone SLT were analyzed. Data collected included demographics, glaucoma type and severity, IOP, and topical IOP-lowering medications before and after both procedures. Eyes were divided into two groups based on success of SLT, defined as IOP reduction of at least 20% maintained on at least two consecutive follow-up visits without any subsequent medication additions or interventions. Phaco/KDB goniotomy success was defined as IOP reduction of at least 20% and/or reduction in the number of IOP-lowering medications of at least one up to 12 months of follow-up.ResultsOverall, SLT was successful in 20 of 43 eyes (46.5%), of which 63.6% (7/11) had successful phaco/KDB goniotomy at 12 months follow-up. Among eyes with unsuccessful SLT, 60.0% (9/15) had successful phaco/KDB at 12 months follow-up. Phaco/KDB success rate was similar in patients regardless of their previous response to SLT at all postoperative time points up to 12 months follow-up (p = 0.87).ConclusionsThe presence or lack of IOP-lowering response to SLT did not influence the success rate of subsequent phaco/KDB goniotomy in eyes with mild to severe OAG. Patients who did not respond to SLT still benefited from phaco/KDB goniotomy at a later date.

Elevated soluble vascular endothelial growth factor receptor levels in aqueous humor from patients with different types of glaucoma

We investigated the aqueous humor levels of vascular endothelial growth factor (VEGF), soluble VEGF receptor (sVEGFR)1, and sVEGFR2 in glaucoma patients and the correlations among them.Aqueous humor was collected from the anterior chamber at the start of glaucoma or cataract surgery. The levels of VEGF and its receptors, sVEGFR1 and sVEGFR2, were measured using multiplex bead-based immunoassays.Aqueous humor samples were obtained from 79 participants: 21 with primary open angle glaucoma (POAG), 22 with uveitic glaucoma (UG), 19 with neovascular glaucoma (NVG), and 17 with cataracts as controls. sVEGFR1 levels were significantly higher in NVG than in the other cases (NVG, 2839.8 pg/mL, P < 0.001). The sVEGFR2 levels of glaucoma patients were significantly higher than those of the controls (POAG, 699.0 pg/mL; UG, 866.2 pg/mL; NVG, 1198.1 pg/mL; P < 0.001). In the aqueous humor of glaucoma patients, sVEGFR1 and sVEGFR2 levels were positively correlated (POAG, P = 0.0196; UG, P = 0.0047; NVG, P = 0.0050). VEGF levels were negatively correlated with both sVEGFR1 (P = 0.0197) and sVEGFR2 (P = 0.0015) in POAG patients. In UG patients, the correlation between VEGF and sVEGFR1 levels was negative (P = 0.0144).sVEGFR2 levels were increased in various glaucomatous eyes. sVEGFR levels were negatively correlated with VEGF levels in some glaucoma types, implying that sVEGFRs may modulate the effects of aqueous VEGF in glaucoma pathogenesis.

The functional polymorphism -863 C/A in the TNF-α gene is associated with primary open-angle glaucoma development in Iraqi patients

Glaucoma is one of the main causes of irreversible blindness. The most common type of glaucoma is primary open-angle glaucoma (POAG). This study aimed to evaluate the possible association between the −863 C/A TNF-α (tumor necrosis factor-alpha) gene polymorphism and −1562 C/T MMP9 (matrix metallopeptidase 9) gene polymorphisms in POAG. Blood samples from apparently healthy controls and patients (40–70 years) with POAG were taken from Baghdad's Ibn Al-Haitham Teaching Eye Hospital. For detecting TNF-α serum levels in peripheral blood, enzyme-linked immunosorbent assay (ELISA) approaches are utilized. Sequence-specific primers with 3 end mismatches were used to amplify the specific allelic variants of −863 C/A TNF-α by sequence-specific primers -polymerase chain reaction (SSP-PCR). The −1562 C/T MMP9 gene polymorphisms were genotyped by the PCR-restriction fragment length polymorphism (PCR-RFLP) method. The mean TNF-α level was significantly elevated in POAG patients (132.85 ± 5.18 pg/ml, P = 0.001) than in the controls (71.52 ± 2.07). The CC genotype of TNF-α is a risk factor for the development of POAG (56, 74.7 %, OR: 2.3158, 95 % CI: 1.1594–4.6256, p = 0.0174) as compared with CA and AA genotypes. The TNF-α (−863) C allele is a risk factor for POAG development (OR: 2.1095, 95 % CI: 1.2207–3.6452, p = 0.0075). The TNF-α (−863) A allele is protective (OR: 0.4741, 95 % CI: 0.2743–0.8192). The results of MMP9 genotyping reveal that none of the three genotypes (TT, TC, and CC) or the two alleles (T and C) are related to POAG development. In conclusion, High levels of TNF-α are associated with POAG. The CC genotype of TNF-α is a risk factor for the development of POAG as compared with CA and AA genotypes. The TNF-α (−863) C allele is a risk factor for POAG while the TNF-α (−863) A allele is protective. No significant difference among the three genotypes (CC, CT, and TT) with POAG development was observed.

Glaucoma in rural China (the Rural Epidemiology for Glaucoma in China (REG-China)): a national cross-sectional study

ObjectiveThis study aimed to investigate the prevalence of glaucoma with associated factors in the rural populations of 10 provinces in China.DesignA population-based cross-sectional study.MethodsAll participants aged 6 years or older...

The efficacy of XEN gel stent implantation in glaucoma: a systematic review and meta-analysis

BackgroundXen is a device for minimally invasive glaucoma surgery, and is used to treat POAG, pseudoexfoliative or pigmentary glaucoma, as well as refractory glaucoma. The efficacy of XEN in treating glaucoma remains to be confirmed and clarified. Hence, we conducted a systematic review and meta-analysis to examine the efficacy and associated complication of XEN implantations.MethodsWe conducted a literature search in PubMed, EMBASE, the Cochrane Library of Systematic Reviews, Web of Science, China National Knowledge Infrastructure, WanFang and SinoMed databases to identify studies, published before May 15, 2021, which evaluated XEN in glaucoma, and parameters for measurements included intra-ocular pressure (IOP), number of anti-glaucoma medications (NOAM), and bleb needling rate. We compared the measurements of XEN-only procedure between phaco-XEN and trabeculectomy, and we also did sub-analysis based on time points, glaucoma types, ethnics, etc. Sensitivity analyses and publication bias were conducted for evaluating bias.This study followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA 2020) reporting guideline.ResultsWe identified 78 eligible studies, analysis revealed obvious IOP reduction after XEN stent implantation (SMD: 1.69, 95% CI 1.52 to 1.86, p value < 0.001) and NOAM reduction (SMD: 2.11, 95% CI 1.84 to 2.38, p value < 0.001). Sub-analysis showed no significant difference with respect to time points, ethnicities, and economic status. No significant difference was found between XEN treatment effect on POAG and PEXG eyes and between pseudo-phakic and phakic eyes. Also no significant difference was found between XEN and phaco-XEN surgery in terms of IOP after surgery (SMD: -0.01, 95% CI -0.09 to 0.08, p value 0.894). However, NOAM (after publication bias correction) and bleb needling rate (RR: 1.45, 95% CI 1.06to 1.99, p value 0.019) were lower in phaco-XEN group compared to XEN only group. Compared to trabeculectomy, XEN implantation had similar after-surgery IOP, however bleb needling rate (RR: 2.42, 95% CI 1.33 to 4.43, p value 0.004) was higher.ConclusionOur results confirmed that XEN is effective in lowering both IOP and NOAM till 48 months after surgery. It is noteworthy that XEN implantation leads to higher needling rate, compared to phaco-XEN or trabeculectomy. Further research, studying complications of XEN on non-European ethnicities, especially on Asian, are in urgent need before XEN is widely applied.