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Translational Vision Science &... Sep 2023The aim of this study was to compare the safety and efficacy of trabeculectomy alone or combined with intravitreal injections of anti-vascular endothelial growth factor... (Meta-Analysis)
Meta-Analysis
OBJECTIVES
The aim of this study was to compare the safety and efficacy of trabeculectomy alone or combined with intravitreal injections of anti-vascular endothelial growth factor (anti-VEGF) agents for the treatment of neovascular glaucoma.
METHODS
We conducted a systematic review and meta-analysis to compare the effects of trabeculectomy alone or combined with intravitreal injections of anti-VEGF agents for the treatment of neovascular glaucoma. We searched four databases (PubMed, Cochrane Library, Embase, and Web of Science) up to January 2023 and extracted data on three surgical outcomes: postoperative intraocular pressure, success rate and complications. We used a random-effects model to calculate pooled relative risk (RR) or standardized mean difference (SMD) estimates and 95% confidence intervals (CIs). We assessed publication bias using Begg and Egger tests.
RESULTS
We included seven studies with 353 eyes. Compared to trabeculectomy alone, trabeculectomy with anti-VEGF had a lower risk of postoperative complications (RR, 0.60; 95% CI, 0.41-0.89) and higher success rate (RR, 1.19; 95% CI, 1.02-1.40). The intraocular pressure reduction was significantly greater in the trabeculectomy with anti-VEGF augmentation group than the trabeculectomy group from 1 week (SMD, -1.36; 95% CI, -2.76 to 0.04) to 6 months (SMD, -0.79; 95% CI, -1.50 to -0.07) after surgery.
CONCLUSIONS
According to current evidence, adding intravitreal injection of anti-VEGF agents to trabeculectomy may improve the short time outcomes of patients with neovascular glaucoma.
Topics: Humans; Trabeculectomy; Glaucoma, Neovascular; Eye; Tonometry, Ocular; Intraocular Pressure
PubMed: 37728893
DOI: 10.1167/tvst.12.9.12 -
International Journal of Molecular... Apr 2024Melatonin's cytoprotective properties may have therapeutic implications in treating ocular diseases like glaucoma and age-related macular degeneration. Literature data... (Review)
Review
Melatonin's cytoprotective properties may have therapeutic implications in treating ocular diseases like glaucoma and age-related macular degeneration. Literature data suggest that melatonin could potentially protect ocular tissues by decreasing the production of free radicals and pro-inflammatory mediators. This study aims to summarize the screened articles on melatonin's clinical, pharmacological, and formulation evaluation in treating ocular disorders. The identification of relevant studies on the topic in focus was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA 2020) guidelines. The studies were searched in the following databases and web search engines: Pubmed, Scopus, Science Direct, Web of Science, Reaxys, Google Scholar, Google Patents, Espacenet, and Patentscope. The search time interval was 2013-2023, with the following keywords: melatonin AND ocular OR ophthalmic AND formulation OR insert AND disease. Our key conclusion was that using melatonin-loaded nano-delivery systems enabled the improved permeation of the molecule into intraocular tissues and assured controlled release profiles. Although preclinical studies have demonstrated the efficacy of developed formulations, a considerable gap has been observed in the clinical translation of the results. To overcome this failure, revising the preclinical experimental phase might be useful by selecting endpoints close to clinical ones.
Topics: Humans; Melatonin; Eye; Glaucoma; Face; Databases, Factual
PubMed: 38612812
DOI: 10.3390/ijms25073999 -
BMJ Open Mar 2024To compare the efficacy and safety of different anti-vascular endothelial growth factor (VEGF) agents combined with different delivery methods for neovascular glaucoma... (Meta-Analysis)
Meta-Analysis
Comparative efficacy and safety of different anti-VEGF agents combined with different delivery methods for neovascular glaucoma: a systematic review and Bayesian network meta-analysis.
OBJECTIVE
To compare the efficacy and safety of different anti-vascular endothelial growth factor (VEGF) agents combined with different delivery methods for neovascular glaucoma (NVG).
DESIGN
Systematic review and Bayesian network meta-analysis (NMA).
DATA SOURCES
PubMed, Embase, Cochrane Library, Web of Science, ClinicalTrials.gov, ISRCTN and Chinese databases including the China National Knowledge Infrastructure, China Science Periodical Database (Wanfang Database), VIP Journal Integration Platform and China Biology Medicine Database were searched from inception to 5 September 2022.
ELIGIBILITY CRITERIA
We included randomised controlled trials (RCTs) that investigated the treatment of NVG using different anti-VEGF agents combined with various methods of drug administration, without any language limitations. All patients included underwent panretinal laser photocoagulation and there were no restrictions on prior glaucoma surgery.
DATA EXTRACTION AND SYNTHESIS
Two independent reviewers extracted data and assessed the risk of bias. Random-effect Bayesian NMA was conducted to compare the efficacy and safety and rank priority of anti-VEGF regimens. The source of heterogeneity and the related factors affecting the stability of the results were also explored. CINeMA (Confidence in Network Meta-Analysis) was used to assess the certainty of evidence.
RESULTS
Our analysis included 17 RCTs involving a total of 1311 eyes from 1228 patients. We examined five different treatment regimens, which used three different anti-VEGF drugs. The following treatments showed a significant decrease in intraocular pressure (IOP) compared with the control group at 1 month after glaucoma surgery: simultaneous intravitreal and intracameral injection of conbercept (ICCIVC) (mean difference (MD)=-11.56, 95% credible interval (CrI) -20.8 to -2.24), intravitreal injection of conbercept (MD=-8.88, 95% CrI -13.93 to -3.78), intravitreal injection of ranibizumab (MD=-7.62, 95% CrI -10.91 to -4.33) and intravitreal injection of bevacizumab IVB) (MD=-5.51, 95% CrI -10.79 to -0.35). The surface under the cumulative ranking curve (SUCRA) analysis indicated that ICCIVC (82.0%) may be the most effective regimen in reducing IOP. In terms of safety, there were no statistically significant differences among the interventions. According to the SUCRA analysis, ICCIVC (68.0%) was considered the safest choice with the fewest complications. Subgroup and meta-regression analyses showed that mean age was the main source of heterogeneity. Sensitivity analysis demonstrated the robustness of the study results.
CONCLUSION
ICCIVC was more effective and safer than other anti-VEGF regimens for NVG. Simultaneous intravitreal and intracameral injection was found to be the best route of administration, and conbercept was found to be the superior drug selection when compared with ranibizumab and bevacizumab.
PROSPERO REGISTRATION NUMBER
CRD42022309676.
Topics: Humans; Glaucoma, Neovascular; Bevacizumab; Network Meta-Analysis; Ranibizumab; Vascular Endothelial Growth Factors; Glaucoma
PubMed: 38443085
DOI: 10.1136/bmjopen-2023-080103 -
PloS One 2024Many forms of childhood glaucoma have been associated with underlying genetic changes, and variants in many genes have been described. Currently, testing is variable as...
Many forms of childhood glaucoma have been associated with underlying genetic changes, and variants in many genes have been described. Currently, testing is variable as there are no widely accepted guidelines for testing. This systematic review aimed to summarize the literature describing genetic changes and testing practices in childhood glaucoma. This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic review and Meta-Analyses (PRISMA) 2020 guidelines and registered with Prospero (ID CRD42023400467). A comprehensive review of Pubmed, Embase, and Cochrane databases was performed from inception through March 2, 2023 using the search terms: (glaucoma) AND (pediatric OR childhood OR congenital OR child OR infant OR infantile) AND (gene OR genetic OR genotype OR locus OR genomic OR mutation OR variant OR test OR screen OR panel). Information was extracted regarding genetic variants including genotype-phenotype correlation. Risk of bias was assessed using the Newcastle-Ottawa Scale. Of 1,916 records screened, 196 studies met inclusion criteria and 53 genes were discussed. Among study populations, mean age±SD at glaucoma diagnosis was 8.94±9.54 years and 50.4% were male. The most common gene discussed was CYP1B1, evaluated in 109 (55.6%) studies. CYP1B1 variants were associated with region and population-specific prevalence ranging from 5% to 86% among those with primary congenital glaucoma. MYOC variants were discussed in 31 (15.8%) studies with prevalence up to 36% among patients with juvenile open angle glaucoma. FOXC1 variants were discussed in 25 (12.8%) studies, which demonstrated phenotypic severity dependent on degree of gene expression and type of mutation. Overall risk of bias was low; the most common domains of bias were selection and comparability. Numerous genes and genetic changes have been associated with childhood glaucoma. Understanding the most common genes as well as potential genotype-phenotype correlation has the potential to improve diagnostic and prognostic outcomes for children with glaucoma.
Topics: Adolescent; Child; Female; Humans; Infant; Male; Genotype; Glaucoma; Glaucoma, Open-Angle; Mutation; Pedigree
PubMed: 38386645
DOI: 10.1371/journal.pone.0298883 -
American Journal of Hypertension Feb 2024Glaucoma is one of the leading causes of global blindness and is expected to co-occur more frequently with vascular morbidities in the upcoming years, as both are...
BACKGROUND
Glaucoma is one of the leading causes of global blindness and is expected to co-occur more frequently with vascular morbidities in the upcoming years, as both are aging-related diseases. Yet, the pathogenesis of glaucoma is not entirely elucidated and the interplay between intraocular pressure, arterial blood pressure (BP) and ocular perfusion pressure is poorly understood.
OBJECTIVES
This systematic review aims to provide clinicians with the latest literature regarding the management of arterial BP in glaucoma patients.
METHODS
A systematic search was performed in Medline, Embase, Web of Science and Cochrane Library. Articles written in English assessing the influence of arterial BP and systemic antihypertensive treatment of glaucoma and its management were eligible for inclusion. Additional studies were identified by revising references included in selected articles.
RESULTS
80 Articles were included in this systemic review. A bimodal relation between BP and glaucoma progression was found. Both high and low BP increase the risk of glaucoma. Glaucoma progression was, possibly via ocular perfusion pressure variation, strongly associated with nocturnal dipping and high variability in the BP over 24 h.
CONCLUSIONS
We concluded that systemic BP level associates with glaucomatous damage and provided recommendations for the management and study of arterial BP in glaucoma. Prospective clinical trials are needed to further support these recommendations.
Topics: Humans; Arterial Pressure; Blood Pressure; Prospective Studies; Glaucoma; Intraocular Pressure
PubMed: 37995334
DOI: 10.1093/ajh/hpad111 -
BMJ Open Ophthalmology Nov 2023This systematic review and meta-analysis aimed to analyse the effect of excess body weight on intraocular pressure (IOP) values. (Meta-Analysis)
Meta-Analysis
OBJECTIVE
This systematic review and meta-analysis aimed to analyse the effect of excess body weight on intraocular pressure (IOP) values.
METHOD AND ANALYSIS
A literature search from PubMed, Medline and ScienceDirect Databases on 18 May 2023 was conducted by three reviewers, then filtered each study based on inclusion and exclusion criteria. For the quality assessment of included studies, the Newcastle-Ottawa Scale was adapted. Meta-analysis was performed using RevMan V.5.4 by entering the IOP values of each group to measure the mean difference.
RESULTS
From 2656 studies, there were 9 studies that matched the criteria and then were included to perform a quantitative meta-analysis. The results showed a mean difference of 0.93 (95% CI: 0.67 to 1.18) of the excessive weight group against the normal weight group. This suggests that there is a significant relationship between excess body weight and increasing values of IOP.
CONCLUSION
It can be concluded that excessive body weight tends to lead to higher IOP, which means that high IOP becomes a major risk factor for glaucoma.
Topics: Humans; Intraocular Pressure; Glaucoma; Tonometry, Ocular; Body Weight; Risk Factors
PubMed: 37963670
DOI: 10.1136/bmjophth-2023-001355 -
Ophthalmic Research 2024Anterior ischemic optic neuropathy (AION) can mimic glaucoma and consequently cause difficulties in differential diagnosis. The purpose of this paper was to summarize... (Review)
Review
INTRODUCTION
Anterior ischemic optic neuropathy (AION) can mimic glaucoma and consequently cause difficulties in differential diagnosis. The purpose of this paper was to summarize differences in diagnostic tests that can help perform a correct diagnosis.
METHODS
The search strategy was performed according to the PRISMA 2009 guidelines, and four databases were used: MEDLINE, Embase, Web of Science, and Cochrane. Totally, 772 references were eligible; 39 were included after screening with respect to inclusion criteria that included English language and published in the 20 years before search date.
RESULTS
Ninety percent (n = 35) of included studies used optical coherence tomography (OCT). Glaucomatous eyes had a significantly greater cup area, volume and depth, cup-to-disk ratio, a lower rim volume and area, and a thinner Bruch's membrane opening-minimum rim width. Retinal nerve fiber layer (RNFL) thinning in glaucomatous eyes occurred primarily at the superotemporal, inferotemporal, and inferonasal sectors, while AION eyes demonstrated mostly superonasal thinning. Glaucoma eyes showed greater macular ganglion cell layer thickness, except at the inferotemporal sector. OCT angiography measurements demonstrated a significant decrease in superficial and deep macular vessel density (VD) in glaucoma compared to AION with similar degree of visual field damage; the parapapillary choroidal VD was spared in AION eyes compared to glaucomatous eyes.
CONCLUSION
By use of OCT imaging, optic nerve head parameters seem most informative to distinguish between glaucoma and AION. Although both diseases affect the RNFL thickness, it seems to do so in different sectors. Differences in structure and vascularity of the macula can also help in making the differential diagnosis.
Topics: Humans; Optic Neuropathy, Ischemic; Diagnosis, Differential; Tomography, Optical Coherence; Nerve Fibers; Retinal Ganglion Cells; Optic Disk; Glaucoma; Visual Fields; Intraocular Pressure
PubMed: 38262372
DOI: 10.1159/000535568 -
Actas Espanolas de Psiquiatria Jun 2024Glaucoma is a chronic disease with an insidious onset that often brings severe psychological burden to patients. Therefore, based on a systematic review and... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
Glaucoma is a chronic disease with an insidious onset that often brings severe psychological burden to patients. Therefore, based on a systematic review and meta-analysis, we explore the prevalence and severity of depression and anxiety in glaucoma patients, and provide clinically valuable information for medical staff.
METHODS
Computer searches were conducted for relevant studies in PubMed, Embase, ProQuest PsycINFO, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Web of Science, The Cochrane Library, Chinese Biomedical Literature Database (CBM), China National Knowledge Infrastructure, Wanfang Database, and China VIP Database. The search date range was from the establishment of the database to December 2023. Literature was screened and data were extracted. The Cochrane risk of bias assessment tool was used to evaluate the quality of the literature, and RevMan5.4 was used for meta-analysis.
RESULTS
The total sample size of the 15 included studies was 24,334 cases. All included studies were of high quality. The results of the meta-analysis revealed that, compared with control patients without glaucoma, patients with glaucoma were more likely to experience depression and to have more severe depressive symptoms [RR (Relative Risk) = 5.92, 95% CI (Confidence Interva) (3.29, 10.66), p < 0.01]; they were also more likely to experience anxiety and to have more severe anxiety symptoms [RR = 2.99, 95% CI (1.93, 4.64), p < 0.01]. The results of the sensitivity analysis showed that the two studies by Cumurcu E. 2005 and Yochim 2012 were the sources of heterogeneity in the meta-analysis of depression; and the three studies by Mabuchi 2012, Otori 2017, and Yochim 2012 were the sources of heterogeneity in the meta-analysis of anxiety disorders.
CONCLUSION
People with glaucoma are more likely to experience depression and anxiety than people without glaucoma. Medical staff should pay greater attention to patients' emotional problems and help patients improve their quality of life.
Topics: Humans; Glaucoma; Prevalence; Cross-Sectional Studies; Anxiety Disorders; Depression; Depressive Disorder
PubMed: 38863056
DOI: 10.62641/aep.v52i3.1561 -
BMC Ophthalmology Feb 2024Africa is one of the continents with a substantial burden of glaucoma, where it is approximately twice as common as it is worldwide. If left untreated, glaucoma can...
BACKGROUND
Africa is one of the continents with a substantial burden of glaucoma, where it is approximately twice as common as it is worldwide. If left untreated, glaucoma can cause blindness and permanent vision loss if it is not addressed promptly. Good knowledge is essential for preventing glaucoma's irreversible blindness and ocular damage. However, no systematic review has been done to report the pooled percentage of adults in Africa who have good knowledge about glaucoma. This study aimed to estimate the level of knowledge about glaucoma in Africa and its determinants.
METHODS
The study followed the PRISMA guidelines for systematic review. Seven electronic databases which include PubMed/MEDLINE, Web of Science, PROQUEST (PQDT), CINAHL (EBSCO), Google Scholar, African Journal Online, and WHO HINARI databases were searched from January 1, 2013, to July 31, 2023for studies conducted with a focus on the knowledge about glaucoma among adults in Africa. The quality of the final articles was assessed using the Joanna Briggs Institute quality assessment tool for cross-sectional studies.
RESULTS
In the present systematic review, 2781 articles were initially identified and evaluated. Of these, eight studies that met the inclusion criteria were included in the final analysis. In this review, the proportion of knowledge about glaucoma among adults in Africa was low. Educational status, family history of glaucoma, occupation, being a male, and having a history of eye examination were the main determinants of good knowledge about glaucoma among adults in Africa.
CONCLUSION
The systematic review found that only a few had good knowledge about glaucoma. Education campaigns and eye exam promotions are recommended to enhance awareness.
TRAIL REGISTRATION
This systematic review was registered on 30/07/2023 with PROSPERO ID: CRD42023430723.
Topics: Adult; Male; Humans; Cross-Sectional Studies; Glaucoma; Africa; Eye; Blindness
PubMed: 38355482
DOI: 10.1186/s12886-024-03333-9 -
Turkish Journal of Ophthalmology Apr 2024To review the current literature related to the correlation between translaminar pressure difference (TLPD) and glaucoma. (Meta-Analysis)
Meta-Analysis
OBJECTIVES
To review the current literature related to the correlation between translaminar pressure difference (TLPD) and glaucoma.
MATERIALS AND METHODS
In this article, we conducted a literature review using MEDLINE via PubMed, Cochrane Eyes and Vision, and Google Scholar from 01/01/2010 to 31/12/2022. Search terms included "glaucoma", "intraocular pressure", "translaminar cribrosa pressure gradient/difference", "intracranial pressure", and "cerebrospinal fluid pressure". Of 471 results, 8 articles were selected for the meta-analysis.
RESULTS
Our meta-analysis demonstrated significantly higher intraocular pressure, lower cerebrospinal fluid pressure (CSFp), and greater TLPD in high-tension and normal-tension glaucoma groups compared to healthy groups.
CONCLUSION
The differences in CSFp and TLPD between glaucoma and healthy people detected in current studies suggests a potential relationship between TLPD and glaucoma.
Topics: Humans; Intraocular Pressure; Optic Nerve Diseases; Cerebrospinal Fluid Pressure; Glaucoma; Tonometry, Ocular; Low Tension Glaucoma
PubMed: 38645613
DOI: 10.4274/tjo.galenos.2024.66267