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Survey of Ophthalmology 2018Cataract extraction is a safe and effective surgery that has been performed in its modern form for several decades. Many studies have noted that cataract extraction... (Meta-Analysis)
Meta-Analysis Review
Cataract extraction is a safe and effective surgery that has been performed in its modern form for several decades. Many studies have noted that cataract extraction could also have a clinically significant role in the control of comorbid glaucoma. Lens extraction decreases the pressure within the eye, and intraocular pressure (IOP) is the only controllable risk factor in glaucoma proven to be effective. A systematic analysis of current evidence is needed to establish strong practice patterns and identify areas where further research is required. We performed systematic review and meta-analysis of the clinical data to estimate the net effect of cataract surgery on IOP. A total of 37 treatment arms from 32 different studies from January 1997 to January 2017 were included. IOP reduction was highly correlated across follow-up periods. For angle-closure glaucoma, results showed an IOP decrease of -6.4 mmHg (95% CI: -9.4 to -3.4) at final follow-up (12 months and longer). For the open-angle glaucoma group, there was an overall IOP change of -2.7 mmHg (95% CI -3.7 to -1.7) from baseline. For pseudoexfoliation glaucoma further research is needed to reach an adequate evidence-based conclusion. The influence of inherent sources of bias, including loss to follow-up, washout and medication use, and lack of a control group, was evaluated numerically. These sources of bias pulled the IOP estimate in opposite directions and are therefore unlikely to affect the main conclusions substantially. Future prospective clinical trials, including other outcomes such as quality of life, clinical severity information, and cost-effectiveness analysis, are needed to determine the role of phacoemulsification alone within the glaucoma treatment algorithm.
Topics: Antihypertensive Agents; Glaucoma; Humans; Intraocular Pressure; Ocular Hypertension; Phacoemulsification
PubMed: 28887138
DOI: 10.1016/j.survophthal.2017.08.006 -
[Zhonghua Yan Ke Za Zhi] Chinese... May 2017To evaluate the rate of blindness caused by primary angle closure glaucoma (PACG) in Chinese population of more than 40 years old, and to explore the effectiveness of a... (Meta-Analysis)
Meta-Analysis Review
To evaluate the rate of blindness caused by primary angle closure glaucoma (PACG) in Chinese population of more than 40 years old, and to explore the effectiveness of a prevention and treatment system on PACG. We searched the databases of Pubmed, ScienceDirect, Springer Link, CNKI and Wanfang Data and collected all the original studies of the prevalence and blindness of angle closure glaucoma in China. The population was limited to over 40 years old. The research site was limited to the community-based, while the published time was not limited. Two researchers completed the literature search, data extraction and methodological quality assessment independently, with same criteria. Meta analysis was performed using R software. Five papers were included in this study finally. A total of 26 437 cases of natural population over the age of 40 were observed, and 306 cases of angle closure glaucoma were found, of which 113 cases had binocular or monocular blindness caused by PACG. The random effect model meta-analysis results showed that the overall blindness rate was 38.3% [95% (28.1%, 49.6%)]. In Beijing, where the prevention and treatment system was well established, the blindness rate was far lower than that in the areas where the system was poorly established. Compared with the past, the blindness rate caused by PACG in Beijing decreased sharply. The rate of blindness caused by PACG is still high in the mainland of China. The prevention and treatment system is effective and worth promoting. -.
Topics: Adult; Aged; Asian People; Beijing; Blindness; China; Databases, Factual; Female; Glaucoma, Angle-Closure; Humans; Male; Middle Aged; Prevalence; Rural Population; Software
PubMed: 28494566
DOI: 10.3760/cma.j.issn.0412-4081.2017.05.010 -
PloS One 2016Chronic glaucoma is a multifactorial disease among which oxidative stress may play a major pathophysiological role. We conducted a systematic review and meta-analysis to... (Meta-Analysis)
Meta-Analysis Review
Chronic glaucoma is a multifactorial disease among which oxidative stress may play a major pathophysiological role. We conducted a systematic review and meta-analysis to evaluate the levels of oxidative and antioxidative stress markers in chronic glaucoma compared with a control group. The PubMed, Cochrane Library, Embase and Science Direct databases were searched for studies reporting oxidative and antioxidative stress markers in chronic glaucoma and in healthy controls using the following keywords: "oxidative stress" or "oxidant stress" or "nitrative stress" or "oxidative damage" or "nitrative damage" or "antioxidative stress" or "antioxidant stress" or "antinitrative stress" and "glaucoma". We stratified our meta-analysis on the type of biomarkers, the type of glaucoma, and the origin of the sample (serum or aqueous humor). We included 22 case-control studies with a total of 2913 patients: 1614 with glaucoma and 1319 healthy controls. We included 12 studies in the meta-analysis on oxidative stress markers and 19 on antioxidative stress markers. We demonstrated an overall increase in oxidative stress markers in glaucoma (effect size = 1.64; 95%CI 1.20-2.09), ranging from an effect size of 1.29 in serum (95%CI 0.84-1.74) to 2.62 in aqueous humor (95%CI 1.60-3.65). Despite a decrease in antioxidative stress marker in serum (effect size = -0.41; 95%CI -0.72 to -0.11), some increased in aqueous humor (superoxide dismutase, effect size = 3.53; 95%CI 1.20-5.85 and glutathione peroxidase, effect size = 6.60; 95%CI 3.88-9.31). The differences in the serum levels of oxidative stress markers between glaucoma patients and controls were significantly higher in primary open angle glaucoma vs primary angle closed glaucoma (effect size = 12.7; 95%CI 8.78-16.6, P < 0.001), and higher in pseudo-exfoliative glaucoma vs primary angle closed glaucoma (effect size = 12.2; 95%CI 8.96-15.5, P < 0.001). In conclusion, oxidative stress increased in glaucoma, both in serum and aqueous humor. Malonyldialdehyde seemed the best biomarkers of oxidative stress in serum. The increase of some antioxidant markers could be a protective response of the eye against oxidative stress.
Topics: Aged; Aqueous Humor; Biomarkers; Case-Control Studies; Chronic Disease; Female; Glaucoma, Angle-Closure; Glaucoma, Open-Angle; Glutathione Peroxidase; Humans; Male; Malondialdehyde; Middle Aged; Oxidative Stress; Superoxide Dismutase
PubMed: 27907028
DOI: 10.1371/journal.pone.0166915 -
Ophthalmology Jun 2016Systematic review and meta-analysis of the genetic associations of primary angle-closure disease (PACD). (Meta-Analysis)
Meta-Analysis Review
TOPIC
Systematic review and meta-analysis of the genetic associations of primary angle-closure disease (PACD).
CLINICAL RELEVANCE
To confirm the genetic biomarkers for PACD, including primary angle-closure glaucoma (PACG) and related phenotypes.
METHODS
We searched in the MEDLINE and EMBASE databases for genetic studies of PACG or other PACD published from the start dates of the databases to May 11, 2015. We estimated the summary odds ratios (ORs) and 95% confidence intervals (CIs) for each polymorphism in PACG, primary angle-closure suspect (PACS), and primary angle-closure (PAC) using fixed- or random-effect models. We also performed sensitivity analysis to test the robustness of the results.
RESULTS
Our literature search yielded 6463 reports. Among them, we identified 24 studies that fulfilled the eligibility criteria for meta-analysis, involving 28 polymorphisms in 11 genes/loci. We affirmed the association of PACG and combined PACS/PAC/PACG with 10 polymorphisms in 8 genes/loci, including COL11A1 (rs3753841-G, OR, 1.22; P = 0.00046), HGF (rs17427817-C, OR, 2.02; P = 6.9E-07; rs5745718-A, OR, 2.11; P = 9.9E-07), HSP70 (rs1043618, GG+GC, OR, 0.52; P = 0.0010), MFRP (rs2510143-C, OR, 0.66; P = 0.012; rs3814762-G, OR, 1.40; P = 0.0090), MMP9 (rs3918249-C, OR, 1.35; P = 0.034), NOS3 (rs7830-A, OR, 0.80; P = 0.036), PLEKHA7 (rs11024102-G, OR, 1.24; P = 8.3E-05), and PCMTD1-ST18 (rs1015213-A, OR, 1.59; P = 0.00013). Sensitivity analysis indicated that the results were robust.
CONCLUSIONS
In this study, we confirmed multiple polymorphisms in 8 genes/loci as genetic biomarkers for PACD, among which 3 were identified in a genome-wide association study (COL11A1, PLEKHA7, and PCMTD1-ST18), and 5 were identified in candidate gene studies (HGF, HSP70, MFRP, MMP9, and NOS3).
Topics: Databases, Factual; Eye Proteins; Genetic Association Studies; Genetic Markers; Genome-Wide Association Study; Genotype; Glaucoma, Angle-Closure; Humans; Polymorphism, Single Nucleotide
PubMed: 26854036
DOI: 10.1016/j.ophtha.2015.12.027 -
Spine Mar 2016A case report and literature review is presented of a patient that developed acute angle-closure glaucoma (AACG) after undergoing spine surgery in the prone position. (Review)
Review
STUDY DESIGN
A case report and literature review is presented of a patient that developed acute angle-closure glaucoma (AACG) after undergoing spine surgery in the prone position.
OBJECTIVES
To report a case of AACG after undergoing spine surgery in the prone position and describe potential causes and implications for future care.
SUMMARY OF BACKGROUND DATA
Visual loss is a devastating complication after spine surgery and is most often due to ischemic optic neuropathy. Although far less common, three cases of AACG have previously been reported, all of which were bilateral. Mydriatric agents and prone positioning were hypothesized as precipitating factors as both are known to increase intraocular pressure. In contrast to other visual loss diseases after spine surgery, AACG is amenable to treatment if recognized and treated early; however, its diagnosis is often complicated by patients presenting days after surgery. We report the case of a 65-year-old male who underwent multilevel revision spine surgery in the prone position and developed unilateral AACG after discharge on postoperative day 5.
METHODS
The case report is described. A literature review was performed using PubMed and keywords. The resulting articles were evaluated and references checked for additional cases.
RESULTS
The case herein resulted in no vision loss after the AACG was treated with laser iridotomy. The patient had a history of ocular issues in the affected side, highlighting the potential role anatomy plays in the development of AACG following spine surgery. Three reports of AACG were found after the literature review was performed.
CONCLUSION
Although it is not practical to screen all patients through ophthalmologic referral, there may be a role for targeted preoperative screening of patients with risk factors for AACG.
LEVEL OF EVIDENCE
5.
Topics: Aged; Glaucoma, Angle-Closure; Humans; Lumbar Vertebrae; Male; Postoperative Complications; Reoperation; Spinal Fusion; Spinal Stenosis
PubMed: 26571166
DOI: 10.1097/BRS.0000000000001224 -
The British Journal of Ophthalmology Jan 2016To evaluate glaucoma prevalence and disease burden across Asian subregions from 2013 to 2040. (Meta-Analysis)
Meta-Analysis Review
PURPOSE
To evaluate glaucoma prevalence and disease burden across Asian subregions from 2013 to 2040.
METHODS
We conducted a systematic review and meta-analysis of 23 population-based studies of 1318 primary open angle glaucoma (POAG) cases in 66,800 individuals and 691 primary angle closure glaucoma (PACG) cases in 72,767 individuals in Asia. Regions in Asia were defined based on United Nations' (UN) classification of macro-geographic regions. PubMed, Medline and Web of Science databases were searched for population-based glaucoma prevalence studies using standardised criteria published to 31 December 2013. Pooled glaucoma prevalence for individuals aged 40-80 years was calculated using hierarchical Bayesian approaches. Prevalence differences by geographic subregion, subtype and habitation were examined with random effects meta-regression models. Estimates of individuals with glaucoma from 2013 to 2040 were based on the UN World Population Prospects.
RESULTS
In 2013, pooled overall glaucoma prevalence was 3.54% (95% credible interval (CrI) 1.83 to 6.28). POAG (2.34%, 95% CrI 0.96 to 4.55) predominated over PACG (0.73%, 95% CrI 0.18 to 1.96). With age and gender adjustment, PACG prevalence was higher in East than South East Asia (OR 5.55, 95% CrI 1.52 to 14.73), and POAG prevalence was higher in urban than rural populations (OR 2.11, 95% CrI 1.57 to 2.38). From 2013 to 2040, South Central Asia will record the steepest increase in number of glaucoma individuals from 17.06 million to 32.90 million compared with other Asian subregions. In 2040, South-Central Asia is also projected to overtake East Asia for highest overall glaucoma and POAG burden, while PACG burden remains highest in East Asia.
CONCLUSIONS
Across the Asian subregions, there was greater glaucoma burden in South-Central and East Asia. Sustainable public health strategies to combat glaucoma in Asia are needed.
Topics: Adult; Aged; Aged, 80 and over; Asia; Asian People; Female; Glaucoma, Angle-Closure; Glaucoma, Open-Angle; Humans; Male; Middle Aged; Prevalence
PubMed: 26112871
DOI: 10.1136/bjophthalmol-2014-306102 -
Clinical & Experimental Ophthalmology Aug 2015Single nucleotide polymorphisms (SNPs) rs11024102 in PLEKHA7 and rs3753841 in COL11A1 were identified to be associated with primary angle closure glaucoma (PACG) by a... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Single nucleotide polymorphisms (SNPs) rs11024102 in PLEKHA7 and rs3753841 in COL11A1 were identified to be associated with primary angle closure glaucoma (PACG) by a recent large genome-wide association study. This present study is to evaluate the association of PLEKHA7 rs11024102 and COL11A1 rs3753841 with PACG.
DESIGN
A systematic review and meta-analysis.
PARTICIPANTS
A total of 25 271 subjects (4895 PACG patients and 20 376 controls) in different ethnicities were tested for PLEKHA7 rs11024102 and COL11A1 rs3753841.
METHODS
A comprehensive literature search was conducted on studies published up to July 2014. Summary odds ratios (ORs) and 95% confidence intervals were analysed. Publication bias of the included articles was evaluated using funnel plots and Egger's test.
MAIN OUTCOME MEASURES
OR for the effects of PLEKHA7 rs11024102 and COL11A1 rs3753841 on PACG risk.
RESULTS
Four eligible articles were included in this study for meta-analysis. The overall result showed that SNPs rs11024102 and rs3753841 were statistically associated with PACG (P < 0.001) in fixed-effects model. Stratified analyses showed that the association of PLEKHA7 rs11024102 and COL11A1 rs3753841 with PACG was statistically significant in Asian population (including South Indian cohort) (P < 0.001). In Caucasian population, significant association of COL11A1 rs3753841 with PACG was detected (P = 0.004), but PLEKHA7 rs11024102 did not show any association with PACG (P = 0.140).
CONCLUSIONS
This meta-analysis suggests that PLEKHA7 rs11024102 is associated with PACG in Asian population and COL11A1 rs3753841 has a genetic association with the development of PACG both in Caucasian and Asian populations.
Topics: Asian People; Carrier Proteins; Case-Control Studies; Collagen Type XI; Genetic Association Studies; Genetic Predisposition to Disease; Glaucoma, Angle-Closure; Humans; Odds Ratio; Polymorphism, Single Nucleotide; Risk Factors; White People
PubMed: 25732101
DOI: 10.1111/ceo.12516 -
Romanian Journal of Ophthalmology 2015The objective of our study was to review the current knowledge on the diagnosis and treatment options of plateau iris configuration and syndrome. (Review)
Review
OBJECTIVES
The objective of our study was to review the current knowledge on the diagnosis and treatment options of plateau iris configuration and syndrome.
SYSTEMATIC REVIEW METHODOLOGY
Relevant publications on plateau iris that were published until 2014.
CONCLUSIONS
Plateau iris syndrome is a form of primary angle closure glaucoma caused by a large or anteriorly positioned ciliary body that leads to mechanical obstruction of trabecular meshwork. This condition is most often found in younger patients. Plateau iris has been considered an abnormal anatomic variant of the iris that can be diagnosed on ultrasound biomicroscopy or optical coherence tomography of anterior segment. Patients with plateau iris syndrome can be recognized by the lack of response in angle opening after iridotomy. The treatment of choice in these cases is argon laser peripheral iridoplasty.
Topics: Argon; Ciliary Body; Diagnosis, Differential; Glaucoma, Angle-Closure; Humans; Iridectomy; Iris; Laser Therapy; Microscopy, Acoustic; Syndrome; Tomography, Optical Coherence; Trabecular Meshwork; Treatment Outcome
PubMed: 27373109
DOI: No ID Found -
Archivos de La Sociedad Espanola de... Mar 2015To present a clinical practice guideline update on the medical, laser, and surgical treatment of primary angle closure glaucoma (PACG) in adults. (Review)
Review
OBJECTIVE
To present a clinical practice guideline update on the medical, laser, and surgical treatment of primary angle closure glaucoma (PACG) in adults.
METHODS
Following the formulation of key questions using the PICO scheme (Patient/Problem, Intervention, Comparison, Outcome), a systematic review was performed on the literature published to date, including international clinical practice guidelines. The AMSTAR and Risk of Bias tools were used for evaluating the quality of the information. The level of evidence and grade of recommendation was established following the Scottish Intercollegiate Guidelines Network (SIGN) system.
RESULTS
Following the above methodology, recommendations of medical, laser and surgical treatment in adult PACG and levels of evidence are presented.
CONCLUSIONS
Although the level of scientific evidence for many of the questions raised is not very high, a review is presented on updated treatment recommendations for adult PACG. Among the limitations for the implementation of these recommendations is that most studies have been conducted in Asian populations, and that the effectiveness is measured almost exclusively in terms of reducing intraocular pressure, and does not include visual function, quality of life or cost-effectiveness parameters.
Topics: Adrenergic beta-Antagonists; Adult; Aged; Antihypertensive Agents; Chronic Disease; Combined Modality Therapy; Drug Therapy, Combination; Evidence-Based Medicine; Glaucoma, Angle-Closure; Humans; Intraocular Pressure; Laser Therapy; Light Coagulation; Meta-Analysis as Topic; Middle Aged; Practice Guidelines as Topic; Prostaglandins F, Synthetic; Randomized Controlled Trials as Topic; Tonometry, Ocular; Young Adult
PubMed: 25459683
DOI: 10.1016/j.oftal.2014.09.014 -
PloS One 2014Primary angle closure glaucoma (PACG) is higher in Asians than Europeans and Africans, with over 80% of PACG worldwide in Asia. Previous estimates of PACG were based... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Primary angle closure glaucoma (PACG) is higher in Asians than Europeans and Africans, with over 80% of PACG worldwide in Asia. Previous estimates of PACG were based largely on early studies, mostly using inappropriate case definitions. Therefore, we did a systematic review and meta-analysis to estimate the prevalence of PACG in adult Asian populations and to quantify its association with age, gender, and region.
METHODS
All primary reports of population-based studies that reported the prevalence of PACG in adult Asian populations were identified. PACG case definition was compatible with the ISGEO definition. Twenty-nine population-based studies were included. The overall pooled prevalence estimates were calculated using a random effect model, and ethnicity-, age- and gender-specific pooled prevalence estimates were also calculated.
RESULTS
The overall pooled prevalence of PACG in those of adult Asians was 0.75% (95% CI, 0.58, 0.96). Ethnicity-specific pooled prevalence estimates were 0.97% (0.22, 4.27) in Middle East group, 0.66% (0.23, 1.86) in South East Asia group, 0.46% (0.32, 0.64) in India group, 1.10% (0.85, 1.44) in China group, and 1.19% (0.35, 3.98) in Japan group, respectively. Age-specific prevalence was 0.21% (0.12, 0.37) for those 40-49 years, 0.54% (0.34, 0.85) for those 50-59 years, 1.26% (0.93, 1.71) for those 60-69 years, and 2.32% (1.74, 3.08) for those 70 years or above. The overall female to male ratio of the PACG prevalence was 1.51∶1 (95% CI 1.01, 2.28).
CONCLUSIONS
PACG affects approximately 0.75% adult Asians, increasing double per decade, and 60% of cases being female. The prevalence rates vary greatly by ethnic region.
Topics: Adult; Aged; Aged, 80 and over; Asia; Asian People; Female; Glaucoma, Angle-Closure; Humans; Male; Middle Aged; Prevalence
PubMed: 25057993
DOI: 10.1371/journal.pone.0103222