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Ophthalmology Oct 2023To apply retinal nerve fiber layer (RNFL) optical texture analysis (ROTA) to investigate the prevalence, patterns, and risk factors of RNFL defects in patients with...
PURPOSE
To apply retinal nerve fiber layer (RNFL) optical texture analysis (ROTA) to investigate the prevalence, patterns, and risk factors of RNFL defects in patients with ocular hypertension (OHT) who showed normal optic disc and RNFL configuration in clinical examination, normal RNFL thickness on OCT analysis, and normal visual field (VF) results.
DESIGN
Cross-sectional study.
PARTICIPANTS
Six hundred eyes of 306 patients with OHT.
METHODS
All participants underwent clinical examination of the optic disc and RNFL, OCT RNFL imaging, and 24-2 standard automated perimetry. To detect RNFL defects, ROTA was applied. The risk score for glaucoma development was calculated according to the Ocular Hypertension Treatment Study and European Glaucoma Prevention Study (OHTS-EGPS) risk prediction model. Risk factors associated with RNFL defects were analyzed using multilevel logistic regression analysis.
MAIN OUTCOME MEASURES
Prevalence of RNFL defects.
RESULTS
The average intraocular pressure (IOP) measured from 3 separate visits within 6 months was 24.9 ± 1.8 mmHg for the eye with higher IOP and 23.7 ± 1.7 mmHg for the eye with lower IOP; the respective central corneal thicknesses were 568.7 ± 30.8 μm and 568.8 ± 31.2 μm. Of 306 patients with OHT, 10.8% (33 patients, 37 eyes) demonstrated RNFL defects in ROTA in at least 1 eye. Of the 37 eyes with RNFL defects, the superior arcuate bundle was the most frequently involved (62.2%), followed by the superior papillomacular bundle (27.0%) and the inferior papillomacular bundle (21.6%). Papillofoveal bundle defects were observed in 10.8% of eyes. The smallest RNFL defect spanned 0.0° along Bruch's membrane opening margin, whereas the widest RNFL defect extended over 29.3°. Age (years) (odds ratio [OR], 1.08; 95% confidence interval [CI], 1.03-1.13), VF pattern standard deviation (decibels [dB]) (OR, 1.82; 95% CI, 1.01-3.29), cup volume (mm) (OR, 1.24; 95% CI, 1.01-1.53), and the OHTS-EPGS risk score (OR, 1.04; 95% CI, 1.01-1.07) were associated with RNFL defects.
CONCLUSIONS
A considerable proportion of patients with OHT who showed no signs of optic disc and RNFL thickness abnormalities on clinical and OCT examination exhibited RNFL defects on ROTA. Axonal fiber bundle defects on ROTA may represent the earliest discernible sign of glaucoma in the glaucoma continuum.
FINANCIAL DISCLOSURE(S)
Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
Topics: Humans; Cross-Sectional Studies; Retinal Ganglion Cells; Visual Fields; Nerve Fibers; Glaucoma; Ocular Hypertension; Intraocular Pressure; Tomography, Optical Coherence
PubMed: 37315588
DOI: 10.1016/j.ophtha.2023.06.004 -
BMC Ophthalmology Sep 2023This systematic review and meta-analysis summarize the evidence for the association between Helicobacter pylori infection and Primary Open-Angle Glaucoma. (Meta-Analysis)
Meta-Analysis
PURPOSE
This systematic review and meta-analysis summarize the evidence for the association between Helicobacter pylori infection and Primary Open-Angle Glaucoma.
METHODS
Eligible studies reporting an association between H. pylori infection and Glaucoma were identified through an extensive search of the Excerpta Medica (EMBASE), Web of Science, Scopus, and PubMed databases and an assessment of the reference list of the top articles until October 2022. Analysis was performed with random effects model using Stata 16.
RESULT
Twenty-four studies were included in the systematic review. This study involved 1602 glaucoma patients and 2800 control individuals. The combined RRs of cohort studies and overall combined ORs of case-control studies showed a significant correlation between H. pylori infection and Glaucoma. Subgroup analysis showed that glaucoma patients had a higher risk of having H. pylori infection if they were residents of Europe countries (Cohort: RR: 1.69; 95% CI: 1.3-2.19) and (Case-Control: RR: 3.71; 95% CI: 2.07-6.64), if they had POAG type (Cohort: RR: 1.76; 95% CI: 1.37-2.27) and (Case-Control: RR: 3.71; 95% CI: 2.934.70), if their diagnostic method of HP was histology (Cohort: RR: 1.95; 95% CI: 1.26-3.01) and (Case-Control: RR: 4.06; 95% CI: 2.28-7.22), and if they were over 60 years old (Cohort: RR: 1.63; 95% CI: 1.33-2.00) and (Case-Control: RR: 2.95; 95% CI: 2.27-3.83).
DISCUSSION
The results of this meta-analysis suggest a statistically significant association between Helicobacter pylori infection and Primary Open-Angle Glaucoma.
Topics: Humans; Middle Aged; Helicobacter Infections; Glaucoma, Open-Angle; Helicobacter pylori; Case-Control Studies; Glaucoma
PubMed: 37697285
DOI: 10.1186/s12886-023-03111-z -
Life Science Alliance Sep 2023Impaired development and maintenance of Schlemm's canal (SC) are associated with perturbed aqueous humor outflow and intraocular pressure. The angiopoietin (ANGPT)/TIE2...
Impaired development and maintenance of Schlemm's canal (SC) are associated with perturbed aqueous humor outflow and intraocular pressure. The angiopoietin (ANGPT)/TIE2 signaling pathway regulates SC development and maintenance, whereas the molecular mechanisms of crosstalk between SC and the neural crest (NC)-derived neighboring tissue, the trabecular meshwork (TM), are poorly understood. Here, we show NC-specific forkhead box ( deletion in mice results in impaired SC morphogenesis, loss of SC identity, and elevated intraocular pressure. Visible-light optical coherence tomography analysis further demonstrated functional impairment of the SC in response to changes in intraocular pressure in NC- mice, suggesting altered TM biomechanics. Single-cell RNA-sequencing analysis identified that this phenotype is predominately characterized by transcriptional changes associated with extracellular matrix organization and stiffness in TM cell clusters, including increased matrix metalloproteinase expression, which can cleave the TIE2 ectodomain to produce soluble TIE2. Moreover, endothelial-specific deletion impaired SC morphogenesis because of reduced TIE2 expression, which was rescued by deleting the TIE2 phosphatase VE-PTP. Thus, Foxc2 is critical in maintaining SC identity and morphogenesis via TM-SC crosstalk.
Topics: Animals; Mice; Aqueous Humor; Glaucoma; Intraocular Pressure; Schlemm's Canal; Trabecular Meshwork
PubMed: 37414529
DOI: 10.26508/lsa.202201721 -
JAMA Network Open Oct 2023Recent studies indicate that alcohol consumption is linked to increased intraocular pressure and higher prevalence of open-angle glaucoma (OAG). However, there is...
IMPORTANCE
Recent studies indicate that alcohol consumption is linked to increased intraocular pressure and higher prevalence of open-angle glaucoma (OAG). However, there is insufficient evidence to establish any correlation between alcohol abstinence and improved outcomes in patients with OAG.
OBJECTIVE
To evaluate the association between alcohol consumption status (and its changes) and risk of incident severe visual impairment (VI) or blindness in patients with newly diagnosed OAG.
DESIGN, SETTING, AND PARTICIPANTS
This retrospective, nationwide, population-based cohort study used the Korean National Health Insurance Service's claims and health examination database to enroll patients who were newly diagnosed with OAG between January 1, 2010, and December 31, 2011, and had been alcohol drinkers before their OAG diagnosis. The cohort was followed up until December 2020. The data were analyzed from February to December 2022.
EXPOSURES
The patients were categorized into 2 groups based on their post-OAG diagnosis alcohol consumption status: sustainers and abstainers. The risks of severe VI or blindness were compared using weighted Cox proportional hazards regression models along with inverse probability of treatment weighting.
MAIN OUTCOMES AND MEASURES
Incident severe VI or blindness.
RESULTS
Among 13 643 patients with newly diagnosed OAG (mean [SD] age, 53.7 [11.9] years; 12 066 men [88.4%]) who were drinkers, 2866 (21.0%) quit drinking after the diagnosis. During 91 366 person-years of follow-up, patients abstaining from alcohol after their OAG diagnosis had a lower risk of severe VI or blindness than did those who had sustained drinking (adjusted hazard ratio [AHR] after inverse probability of treatment weighting, 0.63; 95% CI, 0.45-0.87). Among the sustained drinkers, both mild consumption (<105 g/wk; AHR, 1.52; 95% CI, 1.01-2.28) and moderate to heavy consumption (≥105 g/wk; AHR, 1.78; 95% CI, 1.11-2.86) after OAG diagnosis were associated with higher risk of severe VI or blindness relative to abstainers. Frequent drinking (≥4 d/wk) also was associated with a higher risk of severe VI or blindness (AHR, 2.56; 95% CI, 1.52-4.33) compared with abstinence.
CONCLUSIONS AND RELEVANCE
In this cohort study of patients with OAG who were drinkers, abstaining from alcohol after an OAG diagnosis was associated with lower risk of severe VI or blindness. These findings suggest that lifestyle interventions, such as alcohol abstinence, could be essential for patients with newly diagnosed OAG.
Topics: Male; Humans; Middle Aged; Cohort Studies; Glaucoma, Open-Angle; Retrospective Studies; Alcohol Abstinence; Blindness; Vision Disorders
PubMed: 37856121
DOI: 10.1001/jamanetworkopen.2023.38526 -
Graefe's Archive For Clinical and... Sep 2023We have previously demonstrated that prolonged use of glaucoma medications was associated with a poor surgical outcome of ab interno trabeculotomy (µTLO). Given that...
PURPOSE
We have previously demonstrated that prolonged use of glaucoma medications was associated with a poor surgical outcome of ab interno trabeculotomy (µTLO). Given that almost all types of glaucoma eye drop either enhance the drainage through the uveoscleral pathway or reduce aqueous humor production, we hypothesized that prolonged use of these medications might cause disuse atrophy of the conventional pathway. In contrast, ripasudil increases the conventional outflow and eventually shows a favorable outcome of µTLO. This study aimed to evaluate the effect of ripasudil use on µTLO outcomes.
METHOD
The medical charts of 218 patients who underwent µTLO were analyzed retrospectively. We compared the 1-year outcome between ripasudil users versus nonusers by using propensity score matching. We set the covariates as age, sex, glaucoma types, preoperative intraocular pressure (IOP), the mean deviation values of visual field tests, the presence or absence of concomitant cataract surgery, trabecular meshwork incision range, the presence or absence of any glaucoma medication except ripasudil and duration of glaucoma medical therapy. Success was defined as a postoperative IOP between 5 and 21 mmHg, a ≥ 20% IOP reduction from baseline, and no additional glaucoma surgery at postoperative 1 year.
RESULT
Fifty-seven patients each were allocated to the ripasudil users or nonusers. The 1-year success rates were 74% in ripasudil users and 51% in nonusers (p = 0.01). Kaplan‒Meier survival curves also showed that the ripasudil users had a higher survival distribution (p = 0.01).
CONCLUSION
The patients who took ripasudil showed a favorable 1-year outcome of µTLO.
Topics: Humans; Retrospective Studies; Trabeculectomy; Glaucoma; Intraocular Pressure; Treatment Outcome
PubMed: 37000272
DOI: 10.1007/s00417-023-06040-1 -
Ophthalmology Aug 2023This study aimed to evaluate the efficacy of laser peripheral iridotomy (LPI) prophylaxis for patients with primary angle-closure suspect (PACS) after 14 years and to... (Randomized Controlled Trial)
Randomized Controlled Trial
Fourteen-Year Outcome of Angle-Closure Prevention with Laser Iridotomy in the Zhongshan Angle-Closure Prevention Study: Extended Follow-up of a Randomized Controlled Trial.
PURPOSE
This study aimed to evaluate the efficacy of laser peripheral iridotomy (LPI) prophylaxis for patients with primary angle-closure suspect (PACS) after 14 years and to identify risk factors for the conversion from PACS to primary angle closure (PAC).
DESIGN
Extended follow-up of the Zhongshan Angle-Closure Prevention Study.
PARTICIPANTS
Eight hundred eighty-nine Chinese patients 50 to 70 years of age with bilateral PACS.
METHODS
Each patient received LPI in 1 randomly selected eye, with the fellow untreated eye serving as a control. Because the risk of glaucoma was low and acute angle closure (AAC) occurred only rarely, the follow-up was extended to 14 years despite substantial benefits of LPI reported after the 6-year visit.
MAIN OUTCOME MEASURES
Incidence of PAC, a composite end point including peripheral anterior synechiae, intraocular pressure (IOP) of > 24 mmHg, or AAC.
RESULTS
During the 14 years, 390 LPI-treated eyes and 388 control eyes were lost to follow-up. A total of 33 LPI-treated eyes and 105 control eyes reached primary end points (P < 0.01). Within them, 1 LPI-treated eye and 5 control eyes progressed to AAC. Primary angle-closure glaucoma was found in 2 LPI-treated eyes and 4 control eyes. The hazard ratio for progression to PAC was 0.31 (95% confidence interval, 0.21-0.46) in LPI-treated eyes compared with control eyes. At the 14-year visit, LPI-treated eyes showed more severe nuclear cataract, higher IOP, and larger angle width and limbal anterior chamber depth (LACD) than control eyes. Higher IOP, shallower LACD, and greater central anterior chamber depth (CACD) were associated with an increased risk of end points developing in control eyes. In the treated group, eyes with higher IOP, shallower LACD, or less IOP elevation after the darkroom prone provocative test (DRPPT) were more likely to demonstrate PAC after LPI.
CONCLUIONS
Despite a two-third decrease in PAC occurrence after LPI, the cumulative risk of progression was relatively low in the community-based PACS population over 14 years. Apart from IOP, IOP elevation after DRPPT, CACD, and LACD, more risk factors are needed to achieve precise prediction of PAC occurrence and to guide clinical practice.
FINANCIAL DISCLOSURE(S)
The author(s) have no proprietary or commercial interest in any materials discussed in this article.
Topics: Humans; Iris; Iridectomy; Follow-Up Studies; Glaucoma, Angle-Closure; Treatment Outcome; Intraocular Pressure; Acute Disease; Glaucoma; Laser Therapy; Eye Abnormalities; Lasers; Gonioscopy
PubMed: 37030454
DOI: 10.1016/j.ophtha.2023.03.024 -
Journal of Glaucoma Nov 2023In this case-control study of the Japanese population, including 3207 glaucoma cases, alcohol consumption patterns such as frequency and quantity showed a positive...
PRCIS
In this case-control study of the Japanese population, including 3207 glaucoma cases, alcohol consumption patterns such as frequency and quantity showed a positive association with glaucoma prevalence.
PURPOSE
To examine the association between alcohol consumption patterns and glaucoma.
SUBJECTS AND METHODS
This case-control study evaluated 3207 cases with glaucoma and 3207 matched controls. Patients over 40 years of age were included from 1,693,611 patients admitted to 34 hospitals in Japan. Detailed alcohol consumption patterns (drinking frequency, average daily drinks, and total lifetime drinks) were obtained, as well as various confounding factors, including smoking history and lifestyle-related comorbidities. Conditional logistic regression models were used to calculate odds ratios (ORs) and 95% CIs for glaucoma prevalence.
RESULTS
Drinking frequency showed an association with glaucoma for "a few days/week" (OR, 1.19; 95% CI, 1.03-1.38) and "almost every day/week" (OR, 1.40; 95% CI, 1.18-1.66). Average daily drinks showed an association for ">0-2 drinks/day" (OR, 1.16; 95% CI, 1.03-1.32). Total lifetime drinks showed an association for ">60-90 drink-year" (OR, 1.23; 95% CI, 1.01-1.49) and ">90 drink-year" (OR, 1.23; 95% CI, 1.05-1.44). As alcohol consumption levels differed considerably between men and women, additional analyses were conducted separately for men and women. Among men, drinking frequency of "a few days/week" and "almost every day/week," average daily drinks of ">0-2 drinks/day" and ">2-4 drinks/day," and total lifetime drinks of ">60-90 drink-year" and ">90 drink-year" had an association with glaucoma. Conversely, among women, neither drinking frequency, average daily drinks, nor total lifetime drinks were associated.
CONCLUSIONS
Both the frequency and quantity of alcohol consumption were associated with glaucoma. Further research on gender differences is warranted.
Topics: Male; Humans; Female; Adult; Middle Aged; Alcohol Drinking; Japan; Case-Control Studies; Intraocular Pressure; Glaucoma
PubMed: 37748099
DOI: 10.1097/IJG.0000000000002308 -
International Journal of Molecular... Jul 2023Primary open-angle glaucoma remains a global issue, lacking a definitive treatment. Increased intraocular pressure (IOP) is considered the primary risk factor of the...
Primary open-angle glaucoma remains a global issue, lacking a definitive treatment. Increased intraocular pressure (IOP) is considered the primary risk factor of the disease and it can be caused by fibrotic-like changes in the trabecular meshwork (TM) such as increased tissue stiffness and outflow resistance. Previously, we demonstrated that the sigma-1 receptor (S1R) agonist fluvoxamine (FLU) has anti-fibrotic properties in the kidney and lung. In this study, the localization of the S1R in TM cells was determined, and the anti-fibrotic efficacy of FLU was examined in both mouse and human TM cells. Treatment with FLU reduced the F-actin rearrangement, inhibited cell proliferation and migration induced by the platelet-derived growth factor and decreased the levels of fibrotic proteins. The protective role of the S1R in fibrosis was confirmed by a more pronounced increase in alpha smooth muscle actin and F-actin bundle and clump formation in primary mouse S1R knockout TM cells. Furthermore, FLU demonstrated its protective effects by increasing the production of nitric oxide and facilitating the degradation of the extracellular matrix through the elevation of cathepsin K. These findings suggest that the S1R could be a novel target for the development of anti-fibrotic drugs and offer a new therapeutic approach for glaucoma.
Topics: Humans; Mice; Animals; Trabecular Meshwork; Fluvoxamine; Glaucoma, Open-Angle; Actins; Glaucoma; Cells, Cultured; Fibrosis; Intraocular Pressure; Sigma-1 Receptor
PubMed: 37511406
DOI: 10.3390/ijms241411646 -
BMJ Open Ophthalmology Sep 2023The Medicine and Healthcare products Regulatory Agency reported links of raised intraocular pressure (IOP) with recently implanted EyeCee One intraocular lens (IOL).... (Observational Study)
Observational Study
OBJECTIVE
The Medicine and Healthcare products Regulatory Agency reported links of raised intraocular pressure (IOP) with recently implanted EyeCee One intraocular lens (IOL). This work investigates if glaucomatous eyes were more susceptible to these postoperative IOP rises and if they required more intensive management.
METHODS
Retrospective observational study of all phacoemulsification surgery with implanted EyeCee One IOL, performed between 1 October 2022 and 26 January 2023 inclusive.
ANALYSIS
A significant IOP elevation was defined as an IOP rise of 10 mm Hg or more from preoperative to maximal postoperative IOP reading. The management of all patients who had a significant IOP elevation was reviewed. Glaucoma/ocular hypertension cases were identified and analysed against non-glaucomatous eyes and statistical analysis performed.
RESULTS
112 glaucoma and 671 non-glaucoma cases identified; 19.6% of the glaucoma cohort had a significant postoperative IOP rise compared with 8.9% of patients without glaucoma (OR 2.49 (95% CI 1.45 to 4.20) p=0.0014). In the glaucoma cohort, 12.5% had an increase in the number of topical IOP-lowering agents (mean increase 1.65±1.58), 6.3% required systemic treatment and 2.7% surgical intervention. In the non-glaucoma group, 3.3% required topical treatment (mean number of agents 0.88±1.34), 0.8% required systemic treatment and 0.2% surgical intervention.
CONCLUSION
This study shows that during the time frame in question, patients with glaucoma or ocular hypertension who had an EyeCee One IOL were almost two and a half times more likely to have a postoperative rise of 10 mm Hg or more in IOP following routine cataract surgery, requiring more aggressive management.
Topics: Humans; Lenses, Intraocular; Eye, Artificial; Glaucoma; Ocular Hypertension; Cataract Extraction
PubMed: 37696676
DOI: 10.1136/bmjophth-2023-001433 -
Graefe's Archive For Clinical and... Dec 2023For the treatment of macular edema, in addition to the use of antivascular endothelial growth factors, steroids are also used intravitreally and sub-Tenon. Side effects...
PURPOSE
For the treatment of macular edema, in addition to the use of antivascular endothelial growth factors, steroids are also used intravitreally and sub-Tenon. Side effects include among others cataract formation and elevation of intraocular pressure (IOP). The aim of this retrospective study was to elicit the IOP elevation after administration of various steroidal medication, the time of onset, and the efficacy of the administered IOP-lowering therapies.
METHODS
We included 428 eyes with a postoperative (n = 136), diabetic (n = 148), uveitic macular edema (n = 61), and macular edema after retinal vein occlusion (n = 83). These patients were treated with one or more diverse steroidal agents once or multiple times. These drugs included: triamcinolone acetonide (TMC) as intravitreal injection (TMC IVI) or sub-Tenon (TMC ST), as well as dexamethasone (DXM) and fluocinolone acetonide (FA) intravitreally. An increase of IOP of ≥ 25 mmHg was designated as pathological. A steroid response in anamnesis, the time of onset of IOP rise from the first administration, and the therapy administered were documented.
RESULTS
Of 428 eyes, 168 eyes (39.3%) had IOP elevation up to a mean of 29.7 (SD ± 5.6) mmHg, which occurred at a median of 5.5 months. Steroids most frequently leading to rise of IOP included DXM (39.1% of all eyes receiving that drug), TMC IVI (47.6%), TMC ST combined with DXM (51.5%), DXM with FA (56.8%), and TMC IVI with DXM (57.4%). A Kaplan-Meier analysis and the Log Rank test showed a significant difference (p < 0.001). IOP rise was treated as follows: 119 conservatively (70.8%), and 21 surgically (12.5%, cyclophotocoagulation 8.3%, filtering surgery 1.8%, in 4 the steroidal drug implant was removed 2.4%), and 28 eyes received no therapy (16.7%). Sufficient IOP regulation was achieved in 82 eyes (68.9%) with topical therapy. In 37 eyes (31.1%) with persistently elevated intraocular pressure, topical therapy had to be continued over the follow-up of 20 ± 7 months.
CONCLUSIONS
IOP increases after any type of steroid application are not rare. Results of our study let us suspect that especially therapy with intravitreal dexamethasone, either as a monotherapy or in combination with another steroid, tends to increase IOP more than other steroids. Regular IOP checks are necessary after each steroid administration, with possible initiation of long-term conservative and/or surgical therapy if necessary.
Topics: Humans; Intraocular Pressure; Glucocorticoids; Macular Edema; Incidence; Retrospective Studies; Ocular Hypertension; Triamcinolone Acetonide; Retinal Diseases; Glaucoma; Fluocinolone Acetonide; Intravitreal Injections; Dexamethasone
PubMed: 37432451
DOI: 10.1007/s00417-023-06163-5