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Middle East African Journal of... 2015Glaucoma is a potentially blinding disease that affects millions of people worldwide. The mainstay of treatment is lowering of intraocular pressure (IOP) through the use... (Review)
Review
Glaucoma is a potentially blinding disease that affects millions of people worldwide. The mainstay of treatment is lowering of intraocular pressure (IOP) through the use of medications, laser and/or incisional surgery. The trabecular meshwork (TM) is thought to be the site of significant resistance to aqueous outflow in open angle glaucoma. Theoretically, an incision through TM or TM removal should decrease this resistance and lead to a significant reduction in IOP. This approach, commonly referred to as goniotomy or trabeculotomy, has been validated in the pediatric population and has been associated with long-term IOP control. In adults, however, removal of TM tissue has been historically associated with more limited and short-lived success. More recent evidence, reveals that even adult patients may benefit significantly from removal of diseased TM tissue and can lead to a significant reduction in IOP that is long-lasting and safe. In this review, we discuss current evidence and techniques for ab interno trabeculectomy using various devices in the adult patient.
Topics: Adult; Glaucoma, Open-Angle; Humans; Intraocular Pressure; Tonometry, Ocular; Trabecular Meshwork; Trabeculectomy
PubMed: 25624670
DOI: 10.4103/0974-9233.148345 -
European Review For Medical and... Oct 2020To evaluate the neuroprotective role of phosphoserine (P-Ser) in primary open-angle glaucoma (POAG) patients and to compare its therapeutic effectiveness to placebo...
OBJECTIVE
To evaluate the neuroprotective role of phosphoserine (P-Ser) in primary open-angle glaucoma (POAG) patients and to compare its therapeutic effectiveness to placebo treatment.
PATIENTS AND METHODS
Fifty-one patients (24 males and 27 females) between 35 and 61 years (average 46 years ± 3.8 SD) affected by POAG were enrolled in this study. Patients were divided in two groups: group A included 28 subjects that received an oral P-Ser treatment for 12 months; and group B included 23 subjects that received an oral placebo treatment for 12 months. Complete ophthalmological examination, standard automated perimetric examination, analysis of ON fibers via scanning laser polarimetry and glaucoma staging was performed in all patients at enrolment and 1, 3, 6, and 12 months after. Statistical analysis was performed using STATA 14.0 (Collage Station, TX, USA).
RESULTS
Mean deviation (MD) and pattern standard deviation (PSD) analysis by means of 30-2 full threshold of the visual fields (VFs), retinal nerve fiber layer (RNFL) thickness by means of GDx, and IOP were considered to evaluate P-Ser therapy effectiveness in both groups. A statistically significant improvement (p<0.05) in VF, RNFL thickness and IOP compared to pre-treatment was found in patients in group A.
CONCLUSIONS
Our study shows a significant improvement in several variables in patients with glaucoma treated with P-Ser compared to placebo and suggests a potential neuroprotective effect of P-Ser in treating glaucoma patients in association with the traditional hypotonic topical therapy.
Topics: Administration, Oral; Adult; Female; Glaucoma, Open-Angle; Humans; Male; Middle Aged; Neuroprotective Agents; Phosphoserine
PubMed: 33090380
DOI: 10.26355/eurrev_202010_23186 -
International Journal of Environmental... Feb 2023The aim of the study was to retrospectively evaluate the efficacy and safety of GATT during a 6-month observation period.
AIM
The aim of the study was to retrospectively evaluate the efficacy and safety of GATT during a 6-month observation period.
MATERIAL AND METHODS
The studied group consisted of 69 open-angle glaucoma patients treated with GATT as the only procedure or in combination with cataract surgery. Patients were assessed 1 day, 10 days, 1 month, 3 months, and 6 months after the surgery via standard ophthalmic examination including VF, IOP, and BCVA. The number of medications taken daily and possible complications were checked. Two criteria of success were established (S1: IOP decrease by 30% and S2: IOP lower than 18 mm Hg).
RESULTS
Before the surgery, the mean IOP was 26.94 mmHg and significantly decreased after GATT to 15.59 mmHg at 6M. BCVA did not significantly differ between the visits. The mean MD did not change significantly within the 6-month observation period (-8.20 dB vs. -8.16 dB, = 0.9824), similar to the mean VFI (64.31% vs. 63.05%, = 0.8571). A 30% IOP decrease at 6M visit was obtained in 95.6% of patients, and 37.7% needed medications to stabilize IOP. An IOP lower than 18 mmHg at 6M was obtained in 91.3% of studied patients after the GATT procedure, and in 58.0% without additional medications. The mean number of medications received daily decreased significantly at 6M compared to preoperative results (2.59 at inclusion vs. 0.76 at 6M, = 0.0004). The most frequent complication after surgery was hyphema, which resolved spontaneously within 10 days.
CONCLUSION
The 6-month observation showed that GATT is a minimally invasive glaucoma-surgery technique that enables an effective and safe IOP decrease.
Topics: Humans; Glaucoma, Open-Angle; Follow-Up Studies; Treatment Outcome; Intraocular Pressure; Trabeculectomy; Retrospective Studies; Gonioscopy
PubMed: 36768125
DOI: 10.3390/ijerph20032759 -
Translational Vision Science &... Feb 2024This study aimed to investigate the genetic causal relationships among diet-derived circulating antioxidants, primary open-angle glaucoma (POAG), and glaucoma-related...
PURPOSE
This study aimed to investigate the genetic causal relationships among diet-derived circulating antioxidants, primary open-angle glaucoma (POAG), and glaucoma-related traits using two-sample Mendelian randomization (MR).
METHODS
Genetic variants associated with diet-derived circulating antioxidants (retinol, ascorbate, β-carotene, lycopene, α-tocopherol, and γ-tocopherol) were assessed as absolute and metabolic instrumental variables. POAG and glaucoma-related traits data were derived from a large, recently published genome-wide association study database; these traits included intraocular pressure (IOP), macular retinal nerve fiber layer (mRNFL) thickness, macular ganglion cell-inner plexiform layer (mGCIPL) thickness, and vertical cup-to-disc ratio (vCDR). MR analyses were performed per outcome for each exposure.
RESULTS
We found no causal association between six diet-derived antioxidants and POAG using the International Glaucoma Genetics Consortium data. For absolute antioxidants, the odds ratios (ORs) ranged from 1.011 (95% confidence interval [CI], 0.854-1.199; P = 0.895) per natural log-transformed β-carotene to 1.052 (95% CI, 0.911-1.215; P = 0.490) for 1 µmol/L of ascorbate. For antioxidant metabolites, the OR ranged from 0.998 (95% CI, 0.801-1.244; P = 0.989) for ascorbate to 1.210 (95% CI, 0.870-1.682; P = 0.257) for γ-tocopherol, using log-transformed levels. A similar result was obtained with the FinnGen Biobank. Furthermore, our results showed no significant genetic association between six diet-derived antioxidants and glaucoma-related traits.
CONCLUSIONS
Our study did not support a causal association among six diet-derived circulating antioxidants, POAG, and glaucoma-related traits. This suggests that the intake of antioxidants may not have a preventive effect on POAG and offers no protection to retinal nerve cells.
TRANSLATIONAL RELEVANCE
This study provides valid evidence regarding the use of diet-derived antioxidants for glaucoma patients.
Topics: Humans; Antioxidants; gamma-Tocopherol; Genome-Wide Association Study; Glaucoma, Open-Angle; Mendelian Randomization Analysis; beta Carotene; Diet; Ascorbic Acid; Glaucoma
PubMed: 38411971
DOI: 10.1167/tvst.13.2.20 -
Scientific Reports Feb 2024This paper evaluates the effectiveness and safety of XEN63 stent, either standalone or in combination with phacoemulsification, in patients with primary open-angle...
This paper evaluates the effectiveness and safety of XEN63 stent, either standalone or in combination with phacoemulsification, in patients with primary open-angle glaucoma (POAG). Eighty eyes from 80 patients with medically uncontrolled POAG were assigned to undergo XEN63 implant. The primary outcome was the surgical success, defined as an intraocular pressure (IOP) lowering from preoperative values ≥ 20% and an IOP absolute value between 6 and 18 mmHg, with or without antiglaucoma medications. Forty-three (53.7%) eyes underwent XEN63-standalone and 37(46.2%) eyes a XEN63 + Phacoemulsification procedure. Success rate was 68.8% (55/80) eyes in the overall study sample, 69.8% (30/43) eyes in the XEN63-standalone group; and 67.6% (25/37) eyes in the XEN63 + Phaco group (p = 0.6133). Preoperative IOP was significantly lowered from 22.1 ± 4.9 mmHg and 19.8 ± 3.7 mmHg to 14.7 ± 5.3 mmHg and 13.8 ± 3.4 mmHg in the XEN63-standalone and XEN63 + Phaco groups, respectively (p < 0.0001 each, respectively); without significant differences between them at any of the time-points measured. Preoperative number of ocular-hypotensive drugs was significantly reduced from 2.3 ± 0.8 to 0.3 ± 0.7 drugs, from 2.5 ± 0.7 to 0.3 ± 0.7 drugs; and from 2.0 ± 0.8 to 0.3 ± 0.7 drugs, in the overall, XEN63-standalone, and XEN63 + Phaco groups, respectively. Regarding safety, 3(42.5%) eyes had transient hypotony at some point during the study, although only in one (1.2%) eye was clinically significant. Four (5.0%) eyes underwent a needling, 4 (5.0%) eyes underwent surgical-bleb-revision, 1 (1.2%) eye required a device replacement and 1 (1.2%) eye a device removal due to maculopathy. XEN63, either alone or in combination with phacoemulsification, significantly lowered IOP and reduced the number of ocular hypotensive medications. The rate of ocular hypotony was relatively high, although it was clinically relevant only in one eye.
Topics: Humans; Glaucoma, Open-Angle; Treatment Outcome; Intraocular Pressure; Tonometry, Ocular; Cataract Extraction; Phacoemulsification; Ocular Hypotension; Antihypertensive Agents
PubMed: 38402310
DOI: 10.1038/s41598-024-55287-z -
BMC Ophthalmology Mar 2021To compare plasma fatty acids (FAs) between participants with primary open-angle glaucoma (POAG) and participants without neuropathy in an elderly population and to...
BACKGROUND
To compare plasma fatty acids (FAs) between participants with primary open-angle glaucoma (POAG) and participants without neuropathy in an elderly population and to investigate specific FAs pattern in POAG.
METHODS
We conducted a population-based study in participants older than 75 years. Participants underwent a comprehensive eye examination with optic nerve photographs, visual field test and optic nerve OCT with RNFL thickness measurement. Glaucomatous status was defined according to the International Society for Epidemiologic and Geographical Ophthalmology classification. Lipids were extracted from plasma and FAs methylesters prepared and analyzed by gas chromatography-mass spectrometry.
RESULTS
Among the 1153 participants of the Montrachet study 810 were retained for analysis and 68 had POAG. The mean age was 82.11 ± 3.67. In multivariable analysis FAs levels were not different between POAG participants and controls (P = 0.078). A FAs pattern characterized by high negative weight of gamma-linoleic acid, eicosapentaenoic acid polyunsaturated FAs (PUFAs), Cis-7 hexadecenoic acid monounsaturated FAs (MUFAs) and high positive weight of eicosadienoic acid, docosatetraenoic acid, docosapentaenoic n-6, alpha linoleic acid PUFAs, eicosenoic acid MUFAs, margaric acid and behenic acid saturated FAs was positively associated with POAG. After adjustment for major confounders, individuals in the upper tertile of FAs pattern scores compared with those in the lower tertile were more likely to present POAG (OR = 3.09 [95% CI 1.29-7.40] P = 0.013).
CONCLUSIONS
We found no significant difference regarding isolated plasma FAs between participants with POAG and participants without neuropathy in elderly but specific FAs pattern might be associated with POAG.
Topics: Aged; Aged, 80 and over; Cross-Sectional Studies; Fatty Acids; Glaucoma, Open-Angle; Humans; Intraocular Pressure; Visual Field Tests; Visual Fields
PubMed: 33757477
DOI: 10.1186/s12886-021-01910-w -
Lasers in Medical Science Oct 2023To compare the microvasculature of the optic disc in open-angle glaucoma (OAG) and angle-closure glaucoma (ACG) after trabeculectomy. This study included 34 patients...
To compare the microvasculature of the optic disc in open-angle glaucoma (OAG) and angle-closure glaucoma (ACG) after trabeculectomy. This study included 34 patients divided into two groups based on the angle: (1) the OAG Group, which included 24 eyes from 24 patients, and (2) the ACG Group, which included ten eyes from 10 patients. All patients were subjected to comprehensive ophthalmic examinations. It included best-corrected visual acuity (BCVA), Goldmann applanation tonometry, gonioscopy, slit-lamp biomicroscopy, dilated fundus examination, and stereoscopic examination of the optic disc. The central corneal thickness was measured using a Nidek AL scan optical biometer. The visual field was evaluated by standard automated perimetry using Humphrey Field Analyzer (24-2 Swedish interactive threshold algorithm; Carl-Zeiss Meditec, Dublin, CA). Moreover, optical coherence tomography angiography (OCT-A) was performed utilizing the RTVue XR Avanti scanner (Optovue Inc., Fremont, CA, USA) preoperatively as well as 1 month after surgery. There was a statistically significant increase in optic disc vessel density (VD) in the whole image, radial peripapillary, inferior, superior, temporal, and nasal quadrant in OAG after surgery. Regarding the change in VD after surgery in ACG patients, there was a statistically significant increase in optic disc VD in the whole image, radial peripapillary, inferior, superior, temporal, and nasal quadrant in ACG after surgery.Regarding the percentage of VD change following trabeculectomy surgery, there were highly significant differences between the two groups for the whole image, radial peripapillary, inferior quadrant, and temporal quadrant VD. Statistically significant changes were also observed in the superior and nasal quadrants of VD. However, no significant change in VD was detected within the disc. In conclusion, the optic disc VD improved after the reduction of intraocular pressure (IOP) by surgery in both OAG and ACG. However, ACG demonstrated a significant improvement than the OAG.
Topics: Humans; Optic Disk; Glaucoma, Open-Angle; Glaucoma, Angle-Closure; Trabeculectomy; Visual Field Tests; Intraocular Pressure; Tomography, Optical Coherence
PubMed: 37897567
DOI: 10.1007/s10103-023-03907-x -
Eye (London, England) Jan 2022The role of glaucoma virtual clinics has developed to help meet demand for capacity within busy glaucoma services. There is limited research of patient and clinician...
BACKGROUND
The role of glaucoma virtual clinics has developed to help meet demand for capacity within busy glaucoma services. There is limited research of patient and clinician experiences and perceptions of these clinics and the aim of this study is to provide further information to help improve patient experience and guide service delivery.
METHODS
A mixed methods research design was employed comprising of a patient satisfaction survey, and patient and clinician interviews. Consultant ophthalmologists were recruited from throughout the UK, and patients and data gathering clinical staff recruited from the Manchester Royal Eye Hospital and Bristol Eye Hospital.
RESULTS
We received a total of 148 patient satisfaction questionnaires with an overall response rate of 55.4%. Most respondents were diagnosed with primary open angle glaucoma (33.9%) at Manchester and glaucoma suspect status at Bristol (50.6%). Patients had high levels of confidence in the person conducting the tests (94.8% Manchester, 98.8% Bristol), and most were likely to recommend the service to family or friends (94.8% Manchester, 92.6% Bristol). We interviewed 10 consultant ophthalmologists, 10 data gathering staff and 20 patients. A number of key themes emerged from the transcribed interviews including: patient experience, clinician perception of patient experience, service delivery, staffing and staff experience, and patient safety.
CONCLUSIONS
Glaucoma virtual clinics can be acceptable to both clinicians and patients, including those with a varied complexity of glaucoma and glaucoma-related disease. Dissatisfaction seemed to relate to poor communication or processes and systems within the service rather than complexity of disease.
Topics: Glaucoma; Glaucoma, Open-Angle; Humans; Ocular Hypertension; Patient Satisfaction; Qualitative Research; Surveys and Questionnaires
PubMed: 33686236
DOI: 10.1038/s41433-021-01467-4 -
Journal Francais D'ophtalmologie Feb 2019The purpose of this study was to analyze the change in intraocular pressure (IOP) and glaucoma medications using the XEN Gel Stent as a solo procedure or in association... (Review)
Review
PURPOSE
The purpose of this study was to analyze the change in intraocular pressure (IOP) and glaucoma medications using the XEN Gel Stent as a solo procedure or in association with phacoemulsification in patients with chronic open angle glaucoma (OAG).
METHODS
We included cohort studies with at least one year of follow-up in patients with primary open angle glaucoma (POAG), pseudo-exfoliative glaucoma (PXG) or pigmentary glaucoma (PG) who received a XEN gel stent. The main outcome measure was IOP reduction at 12 months follow-up. Secondary outcomes were the decrease in glaucoma medications 12 months after surgery, frequency and type of postoperative interventions and complication rate.
RESULTS
A total of 8 case series published between 2016 and 2018 were included; six were prospective studies, and two were retrospective. There was no randomized controlled trial. The data concerned a total of 958 eyes of 777 patients. The various studies showed a mean IOP at 12 months between 13 and 16mmHg, which represented an IOP reduction between 25 and 56% (mean: 42%). This decrease was associated with a reduction in glaucoma medications in all studies. The decrease in IOP was significantly greater in XEN implantation as a stand-alone procedure (44%) than in combined surgery (32%) (P<0.05). Transient hypotony (< 1 month) (3%), choroidal detachment or choroidal folds (1.5%), hyphema (1.9%), bleb leak (1.1%) and shallow anterior chamber (1.1%) were the most frequent complications. As for severe complications, four cases of malignant glaucoma (0.4%) and one case of retinal detachment have been reported. In the follow-up period, needling has been required in 32% of cases, and a total of 55 eyes (5.7%) required repeat filtering surgery or cyclodestructive procedure.
CONCLUSION
XEN Gel Stent appears effective for reducing IOP and the number of medications in OAG patients within 1 year postoperatively with an acceptable safety profile. However, vigilant postoperative follow-up and frequent postoperative maneuvers are required.
Topics: Chronic Disease; Cohort Studies; Glaucoma Drainage Implants; Glaucoma, Open-Angle; Humans; Phacoemulsification; Prosthesis Design; Stents; Treatment Outcome
PubMed: 30683533
DOI: 10.1016/j.jfo.2018.12.002 -
JAMA Ophthalmology Jan 2023A 50% reduction of glaucoma-related blindness has previously been demonstrated in a population that was screened for open-angle glaucoma. Ongoing screening trials of...
IMPORTANCE
A 50% reduction of glaucoma-related blindness has previously been demonstrated in a population that was screened for open-angle glaucoma. Ongoing screening trials of high-risk populations and forthcoming low-cost screening methods suggest that such screening may become more common in the future. One would then need to estimate a key component of the natural history of chronic disease, the mean preclinical detectable phase (PCDP). Knowledge of the PCDP is essential for the planning and early evaluation of screening programs and has been estimated for several types of cancer that are screened for.
OBJECTIVE
To estimate the mean PCDP for open-angle glaucoma.
DESIGN, SETTING, AND PARTICIPANTS
A large population-based screening for open-angle glaucoma was conducted from October 1992 to January 1997 in Malmö, Sweden, including 32 918 participants aged 57 to 77 years. A retrospective medical record review was conducted to assess the prevalence of newly detected cases at the screening, incidence of new cases after the screening, and the expected clinical incidence, ie, the number of new glaucoma cases expected to be detected without a screening. The latter was derived from incident cases in the screened age cohorts before the screening started and from older cohorts not invited to the screening. A total of 2029 patients were included in the current study. Data were analyzed from March 2020 to October 2021.
MAIN OUTCOMES AND MEASURES
The length of the mean PCDP was calculated by 2 different methods: first, by dividing the prevalence of screen-detected glaucoma with the clinical incidence, assuming that the screening sensitivity was 100% and second, by using a Markov chain Monte Carlo (MCMC) model simulation that simultaneously derived both the length of the mean PCDP and the sensitivity of the screening.
RESULTS
Of 2029 included patients, 1352 (66.6%) were female. Of 1420 screened patients, the mean age at screening was 67.4 years (95% CI, 67.2-67.7). The mean length of the PCDP of the whole study population was 10.7 years (95% CI, 8.7-13.0) by the prevalence/incidence method and 10.1 years (95% credible interval, 8.9-11.2) by the MCMC method.
CONCLUSIONS AND RELEVANCE
The mean PCDP was similar for both methods of analysis, approximately 10 years. A mean PCDP of 10 years found in the current study allows for screening with reasonably long intervals, eg, 5 years.
Topics: Humans; Female; Aged; Male; Glaucoma, Open-Angle; Retrospective Studies; Glaucoma; Chronic Disease; Sweden
PubMed: 36416831
DOI: 10.1001/jamaophthalmol.2022.5056