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Journal of Glaucoma Feb 2022The Faroe Islands are home to 50,000 genetically isolated people in the North Atlantic. The prevalence of open-angle glaucoma (OAG) in the Faroese population is unknown....
PURPOSE
The Faroe Islands are home to 50,000 genetically isolated people in the North Atlantic. The prevalence of open-angle glaucoma (OAG) in the Faroese population is unknown. Consequently, we conducted a survey to determine the prevalence of OAG in the Faroese population. We also investigated the role of known glaucoma-causing genes in Faroese OAG.
MATERIALS AND METHODS
We conducted a prospective survey of known and newly diagnosed glaucoma patients at the Faroese National Hospital, Landssjukrahusid, Tórshavn between October 1, 2015 to December 31, 2017. In addition we reviewed the only eye care provider in the Faroese Islands by scrutinizing electronic medical records between 2009 and June 15, 2014, October 1, 2015 and the partly overlapping prescriptions for ocular hypotensive medications in 2016 to identify patients with either a diagnosis of glaucoma, a diagnosis of ocular hypertension or a prescription for ocular hypotensive medications. Next, we prospectively confirmed diagnoses with complete eye examinations. Patient DNA samples were tested for variations in known glaucoma-causing genes [myocilin (MYOC), optineurin (OPTN), and TANK binding kinase 1 (TBK1)].
RESULTS
We determined the age-related prevalence of OAG January 1, 2017 in individuals 40 years or older to be 10.7/1000 (1.07%) and highly age-related. A diagnosis of OAG was present in 264 patients, of whom 211 (79.9%) had primary OAG (including normal tension glaucoma), 49 (18.6%) had pseudoexfoliation glaucoma, and 4 (1.5%) had pigmentary glaucoma. Among patients receiving medications for glaucoma, nearly 50% had primary OAG, while the majority of the rest had ocular hypertension or secondary glaucoma. No disease-causing variants were detected in MYOC, OPTN, or TBK1.
CONCLUSIONS
The calculated prevalence of OAG in the Faroe Islands was 1.07%. The absence of MYOC, OPTN, or TBK1 disease-causing variants in Faroese primary OAG patients suggests that a different, potentially unique set of genes may be contributing to the pathogenesis of glaucoma in this population.
Topics: Adult; Glaucoma, Open-Angle; Humans; Intraocular Pressure; Ocular Hypertension; Prevalence; Prospective Studies
PubMed: 34342283
DOI: 10.1097/IJG.0000000000001921 -
Experimental Eye Research Jul 2023A multitude of pharmacological compounds have been shown to lower and control intraocular pressure (IOP) in numerous species of animals and human subjects after topical... (Review)
Review
Identifying new drugs and targets to treat rapidly elevated intraocular pressure for angle closure and secondary glaucomas to curb visual impairment and prevent blindness.
A multitude of pharmacological compounds have been shown to lower and control intraocular pressure (IOP) in numerous species of animals and human subjects after topical ocular dosing or via other routes of administration. Most researchers have been interested in finding drug candidates that exhibit a relatively long duration of action from a chronic therapeutic use perspective, for example to treat ocular hypertension (OHT), primary open-angle glaucoma and even normotensive glaucoma. However, it is equally important to seek and characterize treatment modalities which offer a rapid onset of action to help provide fast relief from quickly rising IOP that occurs in certain eye diseases. These include acute angle-closure glaucoma, primary angle-closure glaucoma, uveitic and inflammatory glaucoma, medication-induced OHT, and other secondary glaucomas induced by eye injury or infection which can cause partial or complete loss of eyesight. Such fast-acting agents can delay or prevent the need for ocular surgery which is often used to lower the dangerously raised IOP. This research survey was therefore directed at identifying agents from the literature that demonstrated ocular hypotensive activity, normalizing and unifying the data, determining their onset of action and rank ordering them on the basis of rapidity of action starting within 30-60 min and lasting up to at least 3-4 h post topical ocular dosing in different animal species. This research revealed a few health authority-approved drugs and some investigational compounds that appear to meet the necessary criteria of fast onset of action coupled with significant efficacy to reduce elevated IOP (by ≥ 20%, preferably by >30%). However, translation of the novel animal-based findings to the human conditions remains to be demonstrated but represent viable targets, especially EP-receptor agonists (e.g. omidenepag isopropyl; AL-6598; butaprost), mixed activity serotonin/dopamine receptor agonists (e.g. cabergoline), rho kinase inhibitors (e.g. AMA0076, Y39983), CACNA2D1-gene product inhibitors (e.g. pregabalin), melatonin receptor agonists, and certain K-channel openers (e.g. nicorandil, pinacidil). Other drug candidates and targets were also identified and will be discussed.
Topics: Animals; Humans; Intraocular Pressure; Glaucoma, Open-Angle; Glaucoma, Angle-Closure; Antihypertensive Agents; Glaucoma; Ocular Hypertension; Blindness; Vision, Low
PubMed: 36958427
DOI: 10.1016/j.exer.2023.109444 -
Nepalese Journal of Ophthalmology : a... Jan 2022This study aims to study a relatively unexplored topic about the causes and managements of early-onset ocular hypertension (OHTN) following the pars plana vitrectomy...
Causes and Managements of Early-Onset Ocular Hypertension Following Pars Plana Vitrectomy with Silicone Oil for Retinal Detachment and Exploration of Trabeculectomy as a Viable Alternative Management: A Pilot Study.
INTRODUCTION
This study aims to study a relatively unexplored topic about the causes and managements of early-onset ocular hypertension (OHTN) following the pars plana vitrectomy with silicone oil (PPV with SO) procedure for retinal detachment. Additionally, to explore the outcome of trabeculectomy in managing such patients.
MATERIALS AND METHODS
This is a retrospective exploratory pilot study. We studied 23 patients who underwent the procedure then subsequently developed ocular hypertension within a month of the procedure. The probable causes for their early-onset ocular hypertension were identified and addressed with medicine, peripheral iridotomy (PI), complete or partial silicone removal. Trabeculoplasty was done in irretractable causes. This study aimed to evaluate the causes of early onset ocular hypertension after pars plana vitrectomy with silicone oil and explore the outcome of different managements including trabeculectomy.
RESULTS
Inflammation (n=11, 47.8%) was the most common cause of early-onset ocular hypertension. Other causes were overfilling/spilling of silicone oil in anterior chamber (n=5, 21.7%), pupillary block (n=4, 17.4%) and angle-recession glaucoma (n=2, 8.69%). Majority of the cases responded to intraocular pressure (IOP) lowering medications (n=11). Three eyes with persistently high intraocular pressure underwent trabeculectomy after which the intraocular pressure was controlled.
CONCLUSION
Even though prior studies have reported that trabeculectomy does not address late-onset ocular hypertension, our study shows that the procedure might be helpful in early-onset ocular hypertension. This is probably because at the time of presentation for early-onset ocular hypertension, silicone has not emulsified, which will not be the case in late-onset ocular hypertension. If a large study also shows that trabeculectomy can correct early-onset ocular hypertension, this information can guide the practices of ophthalmologists whose patients cannot afford expensive glaucoma drainage devices.
Topics: Glaucoma; Humans; Intraocular Pressure; Ocular Hypertension; Pilot Projects; Retinal Detachment; Retrospective Studies; Silicone Oils; Trabeculectomy; Vitrectomy
PubMed: 35996902
DOI: 10.3126/nepjoph.v14i1.35475 -
Investigative Ophthalmology & Visual... May 2021In POAG, elevated IOP remains the major risk factor in irreversible vision loss. Increased TGFβ2 expression in POAG aqueous humor and in the trabecular meshwork (TM)...
PURPOSE
In POAG, elevated IOP remains the major risk factor in irreversible vision loss. Increased TGFβ2 expression in POAG aqueous humor and in the trabecular meshwork (TM) amplifies extracellular matrix (ECM) deposition and reduces ECM turnover in the TM, leading to a decreased aqueous humor (AH) outflow facility and increased IOP. Inhibitor of DNA binding proteins (ID1 and ID3) inhibit TGFβ2-induced fibronectin and PAI-1 production in TM cells. We examined the effects of ID1 and ID3 gene expression on TGFβ2-induced ocular hypertension and decreased AH outflow facility in living mouse eyes.
METHODS
IOP and AH outflow facility changes were determined using a mouse model of Ad5-hTGFβ2C226S/C288S-induced ocular hypertension. The physiological function of ID1 and ID3 genes were evaluated using Ad5 viral vectors to enhance or knockdown ID1/ID3 gene expression in the TM of BALB/cJ mice. IOP was measured in conscious mice using a Tonolab impact tonometer. AH outflow facilities were determined by constant flow infusion in live mice.
RESULTS
Over-expressing ID1 and ID3 significantly blocked TGFβ2-induced ocular hypertension (P < 0.0001). Although AH outflow facility was significantly decreased in TGFβ2-transduced eyes (P < 0.04), normal outflow facility was preserved in eyes injected concurrently with ID1 or ID3 along with TGFβ2. Knockdown of ID1 or ID3 expression exacerbated TGFβ2-induced ocular hypertension.
CONCLUSIONS
Increased expression of ID1 and ID3 suppressed both TGFβ2-elevated IOP and decreased AH outflow facility. ID1 and/or ID3 proteins thus may show promise as future candidates as IOP-lowering targets in POAG.
Topics: Adenoviridae; Animals; Aqueous Humor; Female; Gene Knockdown Techniques; Genetic Vectors; Inhibitor of Differentiation Protein 1; Inhibitor of Differentiation Proteins; Intraocular Pressure; Intravitreal Injections; Mice; Mice, Inbred BALB C; Ocular Hypertension; Tonometry, Ocular; Trabecular Meshwork; Transforming Growth Factor beta2
PubMed: 33938911
DOI: 10.1167/iovs.62.6.3 -
Journal of Glaucoma Jun 2023XEN gel stent and nonpenetrating deep sclerectomy, both either alone or in combination with cataract surgery, significantly lowered the intraocular pressure (IOP) and...
PRCIS
XEN gel stent and nonpenetrating deep sclerectomy, both either alone or in combination with cataract surgery, significantly lowered the intraocular pressure (IOP) and reduced the number of antiglaucoma medications in patients with open angle glaucoma, with no significant differences between them.
PURPOSE
To compare the surgical outcomes of XEN45 implant and nonpenetrating deep sclerectomy (NPDS), either alone or in combination with cataract surgery, in patients with ocular hypertension and open angle glaucoma (OAG). A retrospective and single-center cohort study was conducted on consecutive patients who underwent a XEN45 implant or an NPDS, either alone or in combination with phacoemulsification. The primary endpoint was the mean change in IOP from the baseline to the last follow-up visit. One hundred twenty-eight eyes, 65 (50.8%) eyes in the NPDS group and 63 (49.2%) eyes in the XEN group, were included in the study. The mean preoperative IOP was significantly lowered from 17.6±5.3 mm Hg and 17.8±6.2 mm Hg to 12.6±2.6 mm Hg and 13.8±2.8 mm Hg at month 12 in the XEN and NPDS groups, respectively; P <0.0001 each. At month 12, 70 (54.7%) eyes were classified as a success, with no significant differences between XEN (57.1%; 36/63 eyes) and NPDS (52.3%; 34/65 eyes) (mean difference: 4.8%; 95% CI: -30.5% to 20.8%; P =0.7115). The number of ocular hypotensive medications was significantly reduced in the XEN (from 2.1±0.7-0.2±0.5, P <0.0001) and in the NPDS (from 2.0±0.8 to 0.3±0.6, P <0.0001) groups, with no significant differences between them ( P =0.2629). The incidence of postoperative adverse events in the overall study population was 12.5%, with no significant differences between groups ( P =0.1275). Seven (11.1%) eyes underwent needling (XEN group) and 10 (15.4%) goniopuncture (NPDS group); P =0.4753.
CONCLUSIONS
XEN45 implant and the NPDS, either alone or in combination with cataract surgery, significantly lowered IOP and reduced the number of ocular hypotensive medications in ocular hypertension and patients with open angle glaucoma.
Topics: Humans; Glaucoma, Open-Angle; Intraocular Pressure; Cohort Studies; Retrospective Studies; Treatment Outcome; Glaucoma; Glaucoma Drainage Implants; Stents; Cataract
PubMed: 36897652
DOI: 10.1097/IJG.0000000000002206 -
The British Journal of Ophthalmology Dec 2021This study was performed to examine the prevalence, risk factors and treatment outcome of OHT/glaucoma in Chinese patients with Vogt-Koyanagi-Harada (VKH).
BACKGROUND/AIMS
This study was performed to examine the prevalence, risk factors and treatment outcome of OHT/glaucoma in Chinese patients with Vogt-Koyanagi-Harada (VKH).
METHODS
Retrospective non-interventional case series were conducted on a total of 2281 patients with VKH referred from April 2008 to April 2019. Of these cases, 1457 had a minimum follow-up period of 3 months and were included for this study. Medical records were reviewed for demographic, ocular and treatment data.
RESULTS
Among 2914 eyes of 1457 patients with VKH, 695 (23.9%) eyes of 425 patients (29.2%) developed OHT/glaucoma. The risk factors of OHT/glaucoma included initial BCVA of 20/200 or worse (OR=4.826), final best-corrected visual acuity (BCVA) of 20/50-20/100 (OR=5.341) and final BCVA of 20/200 or worse (OR=4.235), the interval between uveitis attack and referral time interval being 2 months or more (OR=3.318), more than three recurrent episodes (OR=4.177) and posterior synechiae (OR=1.785). The main possible mechanisms of OHT/glaucoma were inflammatory factor-induced open-angle OHT/glaucoma in 277 eyes (39.9%) and pupillary block arising from complete posterior synechiae in 201 eyes (28.9%). In these 695 eyes with OHT/glaucoma, normalised intraocular pressure (IOP) was achieved in 389 eyes (56.0%) following medical treatment. In the remaining 306 eyes, various surgical interventions were performed and a normalised IOP could be achieved in 249 eyes (81.4%).
CONCLUSION
OHT/glaucoma is a common complication in Chinese patients with VKH. Risk factors of OHT/glaucoma included worse acuity at first and final visits, the longer interval between uveitis attack and referral, more recurrent episodes and posterior synechiae.
Topics: Glaucoma; Humans; Intraocular Pressure; Ocular Hypertension; Prevalence; Retrospective Studies; Risk Factors; Uveitis; Uveomeningoencephalitic Syndrome; Visual Acuity
PubMed: 33011689
DOI: 10.1136/bjophthalmol-2020-316323 -
Current Eye Research Apr 2020: The purpose of this study was to investigate the physiological changes of amino acids in the rat retina caused by ocular hypertension.: Adult Wistar rats were used as...
: The purpose of this study was to investigate the physiological changes of amino acids in the rat retina caused by ocular hypertension.: Adult Wistar rats were used as an experimental model of ocular hypertension. Retinas were hydrolyzed with HCl at 108°C to isolate amino acids. Residual amino acids were measured by reverse-phase high-performance liquid chromatography and the total volume of residual amino acids and the ratio of D- and L-amino acids were analyzed. Free D- and L-alanine levels were also measured using two-dimensional HPLC.: The amount of retinal alanine decreased in ocular hypertension compared with the control ( < .05, Student's -test); the amounts of other amino acids did not differ between the two conditions.The D/L ratio of alanine was higher than that of other amino acids. Ocular hypertension reduced the D/L ratio of retinal alanine, while that of other amino acids was unchanged. Ocular hypertension increased the D/L ratio of free alanine.: Ocular hypertension reduced the D/L ratio of retinal alanine, presumably due in large part to alanine peptides.
Topics: Alanine; Animals; Biomarkers; Chromatography, High Pressure Liquid; Disease Models, Animal; Male; Ocular Hypertension; Rats; Rats, Wistar; Retina
PubMed: 31567001
DOI: 10.1080/02713683.2019.1666995 -
Ophthalmology. Glaucoma 2019To quantify patients' preferences for glaucoma outcomes and use this information to prioritize outcomes that are important to patients.
PURPOSE
To quantify patients' preferences for glaucoma outcomes and use this information to prioritize outcomes that are important to patients.
DESIGN
A cross-sectional study using best-worst scaling object case (BWS).
PARTICIPANTS
Two hundred seventy-four participants newly diagnosed with ocular hypertension or mild to moderate open angle glaucoma from three private practices and one academic medical center in the United States.
METHODS
We designed a preference-elicitation survey based on findings from 25 semi-structured, qualitative interviews with patients with glaucoma (reported elsewhere). The survey asked participants to rate the importance of 13 glaucoma outcomes on a Likert scale as a warm-up exercise followed by completion of 13 BWS tasks. For each task, we presented participants a subset of four outcomes from the possible thirteen, and participants chose the most important and least important outcome. Outcomes included in the survey pertain to maintaining ability to perform vision-dependent activities of daily living (e.g., driving), maintaining visual function and perception (e.g., depth perception), minimizing need to take glaucoma drops, not experiencing ocular surface symptoms (e.g., red eyes, teary eyes), and having adequate control of intraocular pressure (IOP). We administered the survey online and analyzed response patterns using conditional logistic regression to determine the relative importance of different outcomes.
MAIN OUTCOME
Ordinal ranking of glaucoma outcomes based on preference weights.
RESULTS
Between September 1, 2017 and February 28, 2018, we invited 1035 patients to complete our survey, among whom 274 (26%) responded. Most participants were older than 65 years of age (146/274, 53%) and currently on IOP-lowering drops (179/274, 65%). Participants identified that outcomes with the largest relative importance weight were having "adequate IOP control" and ability to "drive a car during the day," and the outcomes with the smallest relative importance weights were "maintaining appearance of the eye" and "reducing the number of IOP-lowering drops".
CONCLUSIONS
Determining the relative importance of glaucoma outcomes to patients can help researchers design studies that may better inform clinical and regulatory decision-making. Although IOP is an outcome that researchers often measure in glaucoma clinical trials, patients also prioritized outcomes related to the ability to perform vision-dependent activities such as driving.
Topics: Activities of Daily Living; Aged; Antihypertensive Agents; Cross-Sectional Studies; Female; Glaucoma, Open-Angle; Humans; Intraocular Pressure; Male; Middle Aged; Ocular Hypertension
PubMed: 32355909
DOI: 10.1016/j.ogla.2019.08.007 -
Ophthalmology. Glaucoma 2020To evaluate the effectiveness and safety of primary and adjunctive micropulse cyclophotocoagulation (MPCPC) in the treatment of ocular hypertension (OHT) and glaucoma.
PURPOSE
To evaluate the effectiveness and safety of primary and adjunctive micropulse cyclophotocoagulation (MPCPC) in the treatment of ocular hypertension (OHT) and glaucoma.
DESIGN
Retrospective cohort study.
PARTICIPANTS
Ocular hypertension and all severities of glaucoma (including treatment-naïve and well-sighted eyes) and all types of glaucoma (including normal-tension glaucoma [NTG]).
METHODS
Consecutive eyes with glaucoma or OHT that underwent MPCPC (Iridex Cyclo G6 Glaucoma Laser System, Mountain View, CA) between 2016 and 2018 were identified.
MAIN OUTCOME MEASURES
Intraocular pressure (IOP), visual acuity, glaucoma medications, and ocular adverse events.
RESULTS
Three hundred ninety-nine MPCPC surgeries, on 342 eyes of 214 patients, were analyzed. Laser power ranged from 900 to 2800 mW. Main diagnoses in descending prevalence were primary open-angle glaucoma (55.9%), chronic angle-closure glaucoma (10.8%), neovascular glaucoma (9.0%), NTG (6.5%), and OHT (5.5%). Mean baseline IOP was 19.8±7.4 mmHg and IOP reduction was 22.7%, 20.2%, 20.7%, and 23.7% at postoperative months (POMs) 1, 3, 6, and 12 (P < 0.0001 for all time points). The end point of 20% or more mean IOP reduction from baseline was achieved by 67.8% of the study cohort at POM 12. Additional mean IOP reduction of 16.4% (P < 0.0001) was achieved with each re-treatment. Analysis based on IOP stratification demonstrated 30.5% mean IOP reduction at POM 12 when baseline IOP was more than 21 mmHg and 20.1% when it was 21 mmHg or less (71% of overall cohort; P < 0.0001). Analysis based on laser power stratification demonstrated mean IOP reduction of 31.5% at POM 12 with laser power of 2500 mW or more and 17.8% with laser power of less than 2500 mW (P < 0.02). Overall, the mean number of topical glaucoma medications was unchanged from baseline to POM 12. Greater baseline IOP and number of baseline topical glaucoma medications were significant predictors of effectiveness in the regression analysis. No patients demonstrated persistent inflammation or hypotony, phthisis bulbi, or sympathetic ophthalmia.
CONCLUSIONS
In patients with OHT or glaucoma, MPCPC demonstrated effectiveness and safety in IOP reduction sustained to 1 year. Baseline IOP of 21 mmHg or less subgroup demonstrated a more limited response. A dose-response relationship is suggested with respect to laser power and repeat treatments.
Topics: Adult; Aged; Aged, 80 and over; Antihypertensive Agents; Ciliary Body; Female; Filtering Surgery; Follow-Up Studies; Glaucoma, Open-Angle; Humans; Intraocular Pressure; Laser Coagulation; Male; Middle Aged; Ocular Hypertension; Retrospective Studies; Tonometry, Ocular; Treatment Outcome; Visual Acuity
PubMed: 32672613
DOI: 10.1016/j.ogla.2020.02.005 -
European Journal of Ophthalmology Sep 2020To report a case of phacolytic glaucoma with rupture of anterior lens capsule in a case of hypermature cataract. (Review)
Review
PURPOSE
To report a case of phacolytic glaucoma with rupture of anterior lens capsule in a case of hypermature cataract.
METHODS
Case report and literature review.
RESULTS
An 80-year-old woman presented with cloudiness and pain in the left eye for 1 day. The patient had visual acuity limited to perception of light with raised intraocular pressure of 70 mm Hg. Careful slit-lamp evaluation revealed corneal epithelial edema in superior quadrant and a deep and turbid anterior chamber. Ultrasound biomicroscopy confirmed the presence of a deep anterior chamber, a hypermature cataractous nucleus with lax capsular bag, and ruptured anterior lens capsule. The patient underwent extracapsular cataract extraction. Cytological examination of the lenticular fluid revealed the presence of lens protein-laden macrophages. Post-operatively, the patient had best-corrected visual acuity of 6/60 with advanced glaucomatous optic neuropathy.
CONCLUSION
Phacolytic glaucoma can present with a cloudy cornea and a turbid anterior chamber mimicking endophthalmitis. Careful examination and ancillary investigations including ultrasound biomicroscopy was helpful in making an accurate diagnosis.
Topics: Aged, 80 and over; Anterior Capsule of the Lens; Anterior Chamber; Antihypertensive Agents; Cataract; Cataract Extraction; Corneal Diseases; Female; Glaucoma; Humans; Intraocular Pressure; Lens Nucleus, Crystalline; Microscopy, Acoustic; Ocular Hypertension; Tonometry, Ocular; Visual Acuity
PubMed: 30950286
DOI: 10.1177/1120672119841972