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Ophthalmology. Glaucoma Apr 2024To identify and quantify medications causing angle-closure glaucoma through the FDA Adverse Event Reporting System (FAERS).
OBJECTIVE
To identify and quantify medications causing angle-closure glaucoma through the FDA Adverse Event Reporting System (FAERS).
DESIGN
National retrospective database analysis.
SUBJECTS
There were 11 737 133 total adverse event reports from the FDA Federal Adverse Event Reporting System (FAERS) database 2004 to third quarter of 2023 (2023Q3), which included 1629 reports of angle-closure glaucoma.
METHODS
Drugs associated with reports of angle-closure glaucoma were identified in FAERS through disproportionality analysis MAIN OUTCOME MEASURES: To ascertain if these reports yielded statistically significant signals, we used the proportional reporting ratio (PRR), reporting odds ratio (ROR), empirical Bayes geometric mean (EBGM), and information component (IC). We considered a signal to be detected when all 4 disproportionality analysis metrics were positive.
RESULTS
We identified a total of 1629 adverse event reports linked to 611 suspected drugs over the course of 20 years (2004-2023Q3). Frequently reported drugs included topiramate (520 reports) and citalopram (69 reports), amongst many others. Eighteen medications yielded a positive signal, including lesser-known medications like olanzapine, phentermine, and ranibizumab. Tropicamide exhibited the most robust statistical significance (n = 18; PRR: 164.263; ROR [95% confidence interval {CI}]: 167.95 [104.994-268.655]; EBGM [EBGM05]: 162.421 [109.5]; IC [IC05]: 7.344 [4.591]), while acetazolamide was the second strongest (n = 51; PRR: 113.088; ROR 95% CI: 114.782 [86.665-152.021]; EBGM [EBGM05]: 109.506 [86.501]; IC [IC05]: 6.775 [5.115]).
CONCLUSIONS
Drug-induced glaucoma included both well-known medications such as topiramate as well as lesser-known medications such as olanzapine, phentermine, and ranibizumab. Clinician awareness of these findings is important.
FINANCIAL DISCLOSURE(S)
Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
PubMed: 38679326
DOI: 10.1016/j.ogla.2024.04.006 -
International Journal of Molecular... Apr 2024This study investigated the association between apolipoprotein E () gene polymorphisms (rs429358 and rs7412) and primary angle-closure glaucoma (PACG) and...
This study investigated the association between apolipoprotein E () gene polymorphisms (rs429358 and rs7412) and primary angle-closure glaucoma (PACG) and pseudoexfoliation glaucoma (PXG) in a Saudi cohort. Genotyping of 437 DNA samples (251 controls, 92 PACG, 94 PXG) was conducted using PCR-based Sanger sequencing. The results showed no significant differences in the allele and genotype frequencies of rs429358 and rs7412 between the PACG/PXG cases and controls. Haplotype analysis revealed ε3 as predominant, followed by ε4 and ε2 alleles, with no significant variance in PACG/PXG. However, genotype analysis indicated a significant association between ε2-carriers and PACG (odds ratio = 4.82, 95% CI 1.52-15.26, = 0.007), whereas no notable association was observed with PXG. Logistic regression confirmed ε2-carriers as a significant predictor for PACG ( = 0.008), while age emerged as significant for PXG ( < 0.001). These findings suggest a potential role of ε2-carriers in PACG risk within the Saudi cohort. Further validation and larger-scale investigations are essential to elucidate the precise role of in PACG pathogenesis and progression.
Topics: Female; Humans; Male; Alleles; Apolipoprotein E2; Case-Control Studies; Gene Frequency; Genetic Predisposition to Disease; Genotype; Glaucoma, Angle-Closure; Haplotypes; Heterozygote; Polymorphism, Single Nucleotide; Risk Factors; Saudi Arabia
PubMed: 38674156
DOI: 10.3390/ijms25084571 -
Acute Myopic Shift after a Single Dose of Acetazolamide: A Case Report and Review of the Literature.Klinische Monatsblatter Fur... Apr 2024We report the case of a 32-year-old male who presented with an acute myopic shift as a result of uveal effusion following a single administration of 250 mg... (Review)
Review
We report the case of a 32-year-old male who presented with an acute myopic shift as a result of uveal effusion following a single administration of 250 mg acetazolamide. The drug was discontinued and following cycloplegia and topical steroid therapy, we observed progressive deepening of the anterior chamber, reopening of the iridocorneal angle, and complete resolution of the myopic shift after 5 days. A literature review since 1956 identified 23 cases, including ours, which developed a myopic shift after a median time of 24 h (3 - 24) following a median dose of 500 mg (125 - 1000) acetazolamide, with about a third complicated by angle closure ocular hypertension. This presumed idiosyncratic reaction can occur without prior drug exposure and independent of the phakic status. Treatment options include systematic drug withdrawal associated with cycloplegia, anti-glaucomatous agents, and/or corticosteroids. Full recovery is achieved within about 5 days (2 - 14). Given the widespread use of acetazolamide, awareness of this idiosyncratic reaction is crucial to avoid complications of acute angle-closure glaucoma.
Topics: Humans; Acetazolamide; Male; Adult; Myopia; Carbonic Anhydrase Inhibitors; Acute Disease; Treatment Outcome
PubMed: 38653306
DOI: 10.1055/a-2244-6160 -
Frontiers in Medicine 2024Angle-closure glaucoma is a common type of glaucoma in Asian populations. However, the role of inflammatory cytokines in angle-closure glaucoma is yet to be elucidated....
INTRODUCTION
Angle-closure glaucoma is a common type of glaucoma in Asian populations. However, the role of inflammatory cytokines in angle-closure glaucoma is yet to be elucidated. Therefore, this study aimed to examine the expression of interleukin-4 (IL-4) and IL-12 in the aqueous humor of patients with chronic primary angle-closure glaucoma (CPACG) and elucidate the correlations between IL-4 and IL-12 concentrations in the aqueous humor, the degree of visual field defects, and retinal nerve fiber layer (RNFL) thickness in patients with CPACG.
METHODS
Aqueous humor samples were obtained from 31 patients diagnosed with CPACG at the Shaoxing People's Hospital between April 2022 and March 2023 and from 30 individuals with cataract (control). Based on the degree of the mean defect (MD), patients were divided into three groups: group A (MD ≤ -6dB, n= 10), group B (-6dB< MD< -12dB, n= 9), and group C (MD ≥ - 12dB, n= 12). RNFL thickness was measured using an optical coherence tomograph, and the concentrations of IL-4 and IL-12 in the aqueous humor were measured using Luminex technology.
RESULTS
Aqueous humor concentration of IL-4 was significantly higher ( = 0.036) in the CPACG group than in the cataract group. However, there was no significant difference ( > 0.05) in IL- 12 concentration between the two groups. Additionally, there were no significant differences ( > 0.05) in IL-4 and IL-12 levels among patients with varying degrees of visual field defects (groups A, B, and C). Spearman's correlation analysis showed that IL-4 and IL-12 concentrations were not correlated ( > 0.05) with RNFL thickness around the optic disc and the degree of visual field defects.
DISCUSSION
Conclusively, IL-4 may play an important role in the pathogenesis of CPACG. Given that IL-4 and IL-12 concentrations in the aqueous humor were not significantly correlated with RNFL thickness and the degree of visual field defects, the increase in IL-4 and IL-12 expression may not induce apoptosis and loss of retinal ganglion cells or affect RNFL thickness as well as the degree of visual field defects.
PubMed: 38651060
DOI: 10.3389/fmed.2024.1323829 -
Indian Journal of Ophthalmology May 2024
Topics: Humans; COVID-19; SARS-CoV-2; Glaucoma, Angle-Closure; Acute Disease; Male; Female; Middle Aged; Pandemics; Aged; Intraocular Pressure
PubMed: 38648443
DOI: 10.4103/IJO.IJO_1539_23 -
Journal of Ophthalmic & Vision Research 2024Glaucoma is the leading cause of irreversible blindness worldwide. Among all glaucoma types, primary angle closure glaucoma (PACG) affects approximately 23 million... (Review)
Review
Glaucoma is the leading cause of irreversible blindness worldwide. Among all glaucoma types, primary angle closure glaucoma (PACG) affects approximately 23 million people worldwide, and is responsible for 50% of glaucoma-related blindness, highlighting the devastating consequences of this disease. The main mechanism of PACG is relative pupillary block. High-risk populations are female gender, Asian ethnicity, high hyperopia, short axial length, and a thick/anteriorly positioned lens. This review discusses the clinical diagnosis, classification, and management of patients with a narrow angle with and without intraocular pressure (IOP) elevation and glaucomatous optic nerve damage, including laser peripheral iridotomy (LPI), endocycloplasty (ECPL), lens extraction, and goniosynechialysis.
PubMed: 38638634
DOI: 10.18502/jovr.v19i1.15443 -
Ophthalmology. Glaucoma Apr 2024Compare outcomes of tube shunt surgery (Tube) and trabeculectomy with mitomycin C (Trab-MMC) in patients with angle-closure glaucoma (ACG).
PURPOSE
Compare outcomes of tube shunt surgery (Tube) and trabeculectomy with mitomycin C (Trab-MMC) in patients with angle-closure glaucoma (ACG).
DESIGN
Retrospective nonrandomized comparative study.
PARTICIPANTS
A total of 80 eyes from 80 patients with ACG who underwent either Tube (N = 50) or Trab-MMC (N = 30) between January 2015 and January 2022 at Massachusetts Eye and Ear.
METHODS
Reviewed and analyzed 390 visits from patient charts.
MAIN OUTCOME MEASURES
Kaplan-Meier (KM) success rates, intraocular pressure (IOP), medication burden, best-corrected visual acuity (BCVA), adjusted hazard ratios (HRs), and complications.
RESULTS
Baseline demographics were similar between both groups, except for a higher proportion of patients with pseudophakia and prior incisional ocular surgery in the Tube group. The Trab-MMC procedure had significantly higher KM complete success (CS) rates than the Tube procedure, but similar qualified success (QS) rates. Under QS, the cumulative probability of survival was 87% in the Tube group and 83% in the Trab-MMC group at year 1 (P = 0.77), and 75% in the Tube group and 58% in the Trab-MMC group at year 2 (P = 0.14). Under CS, the cumulative probability of survival was 13% in the Tube group and 59% in the Trab-MMC group at year 1 (P < 0.001), and 11% in the Tube group and 41% in the Trab-MMC group at year 2 (P < 0.001). Both Tube and Trab-MMC procedures resulted in significant patterns of IOP and medication reduction from baseline up to 2 years with mean IOP reduced to 12.6 ± 5.9 mmHg on 2.8 ± 1.4 medications after Tube and 12.1 ± 6.6 mmHg on 2.4 ± 1.7 medications after Trab-MMC. Patients who underwent Trab-MMC required less IOP-lowering medications at every follow-up visit up to year 1, but a similar number at year 2. No significant differences were found in IOP reduction, BCVA, or complication rates between groups.
CONCLUSIONS
We demonstrate that Trab-MMC confers similar IOP reduction and QS rates to Tube placement in patients with ACG. Trab-MMC, however, demonstrated greater medication burden reduction up to 1 year, and more favorable CS rates up to 2 years, while still maintaining similar complication rates to Tube.
FINANCIAL DISCLOSURE(S)
The author(s) have no proprietary or commercial interest in any materials discussed in this article.
PubMed: 38636705
DOI: 10.1016/j.ogla.2024.04.005 -
Indian Journal of Ophthalmology Jul 2024In the field of ophthalmology, slit-lamp gonioscopy has long been a cornerstone for examining anterior chamber angles and diagnosing conditions such as angle closure,...
In the field of ophthalmology, slit-lamp gonioscopy has long been a cornerstone for examining anterior chamber angles and diagnosing conditions such as angle closure, secondary causes of raised intraocular pressure, neovascularization of angle, angle recession, angle tumors, and foreign bodies. However, the conventional approach for goniophotography is a demanding procedure requiring juggling a gonioscopy lens in one hand and a smartphone in the other. Balancing a gonioscopy lens with one hand makes it difficult to adjust and focus the image in busy clinical settings. This article introduces a groundbreaking solution to this problem - a universal slit-lamp-mounted gonioscope ingeniously repurposed from discarded materials, that is, indirect goniophotography (IndiGo). This novel system simplifies the process of both gonioscopy and goniophotography, allowing ophthalmologists to easily assess anterior chamber angles and capture high-quality images. These images can be swiftly shared with glaucoma specialists worldwide for digital analysis. Not only does this approach enhance examination efficiency, but also it fosters sustainability in ophthalmic diagnostics.
Topics: Gonioscopy; Humans; Intraocular Pressure; Equipment Design; Glaucoma, Angle-Closure; Anterior Chamber; Slit Lamp; Slit Lamp Microscopy
PubMed: 38634755
DOI: 10.4103/IJO.IJO_3035_23 -
Frontiers in Medicine 2024SCUBA diving exposes participants to a unique hyperbaric environment, but few studies have examined the effects of such an environment on intraocular pressure (IOP) and...
PURPOSE
SCUBA diving exposes participants to a unique hyperbaric environment, but few studies have examined the effects of such an environment on intraocular pressure (IOP) and glaucoma. This systematic review aims to consolidate recent literature findings regarding the impact of increased atmospheric pressure on IOP and glaucoma.
METHODS
Three online databases were searched to identify publications encompassing the subjects of diving or increased atmospheric pressure in conjunction with IOP or glaucoma. Three reviewers independently screened the publications and identified eligible articles. Relevant data was extracted from each article. The heterogeneity of the data precluded the conduct of a meta-analysis.
RESULTS
Nine studies met the inclusion criteria. Six experimental studies employed hyperbaric chambers to measure IOP under simulated diving conditions. Among these, IOP exhibited a reduction with increased atmospheric pressures in four studies, while the findings of two studies were inconclusive. One study measured IOP pre- and post-dive and another measured IOP with and without a diving mask. Post-dive, a decrease in IOP was observed, and a statistically significant reduction was noted when subjects wore a diving mask. A retrospective study examining the incidence of acute angle closure glaucoma attack found no association with weather or atmospheric pressure.
CONCLUSION
The majority of studies found IOP to decrease with increased atmospheric pressure and after diving. The mechanisms underlying this reduction remain incompletely understood, with potential contributors including changes in ocular blood flow, sympathetic responses, and increased oxygenation. Hyperbaric chambers may have potential in future glaucoma treatments, but more studies are required to draw reliable conclusions regarding the safety of diving for glaucoma patients.
PubMed: 38633303
DOI: 10.3389/fmed.2024.1365259 -
BMJ Open Ophthalmology Apr 2024To investigate the characteristics of beta parapapillary atrophy (β-PPA) in patients with primary angle-closure suspect (PACS). (Observational Study)
Observational Study
OBJECTIVE
To investigate the characteristics of beta parapapillary atrophy (β-PPA) in patients with primary angle-closure suspect (PACS).
METHODS AND ANALYSIS
In total, 215 and 259 eyes with PACS and non-PACS (NPACS), respectively, were enrolled in this observational, cross-sectional study. Stereoscopic fundus and optical coherence tomography images were used to characterise β-PPA; the former was also used to measure the major β-PPA parameters. Univariate and multiple logistic regression analyses were used to identify the factors correlated with the presence of β-PPA and with β-PPA parameters.
RESULTS
The β-PPA occurrence rates were 48.80% and 44.40% in the PACS and NPACS groups, respectively, with no significant difference between groups. Compared with that in the NPACS group, the β-PPA area was significantly larger (p=0.005) in the PACS group, but the angular extent and maximum radial length did not differ between groups (p=0.110 and 0.657, respectively) after adjusting for age and axial length. The presence of β-PPA was associated with older age (OR 1.057, 95% CI 1.028 to 1.088, p<0.001) and larger disc area (OR 1.716, 95% CI 1.170 to 2.517, p=0.006). A larger β-PPA area was associated with older age (p=0.014), greater vertical cup-to-disc ratio (p=0.028), larger disc area (p<0.001) and PACS diagnosis (p=0.035).
CONCLUSION
48.80% of participants with PACS had β-PPA, which is slightly larger than NPACS. The area of β-PPA was larger in PACS, while the angular extent and maximum radial length did not differ between groups.
Topics: Humans; Optic Disk; Glaucoma, Open-Angle; Optic Atrophy; Cross-Sectional Studies; Intraocular Pressure; Visual Fields; Atrophy; Eye Diseases, Hereditary
PubMed: 38626931
DOI: 10.1136/bmjophth-2023-001529