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International Journal of Ophthalmology 2024
PubMed: 38239950
DOI: 10.18240/ijo.2024.01.25 -
Journal of Cellular and Molecular... Feb 2024Primary angle-closure glaucoma (PACG) is the leading cause of irreversible blindness in the world. Angle closure induced by pupil block and secondary iris synechia is...
Primary angle-closure glaucoma (PACG) is the leading cause of irreversible blindness in the world. Angle closure induced by pupil block and secondary iris synechia is the fundamental pathology of the PACG. The molecular mechanisms of angle closure have not yet been clearly illustrated. This study was designed to investigate the protein difference in the aqueous humour and explore new biomarker of the PACG. Aqueous humour (AH) was collected from patients with acute primary angle closure (APAC) and cataract (n = 10 in APAC group) and patients with cataract only (n = 10 in control group). Samples were pooled and measured using label-free proteome technology. Then, the differentially expressed proteins (DEPs) were verified by ELISA using independent AH samples (n = 20 each group). More than 400 proteins were revealed in both groups through proteomics. Comparing the two groups, there were 91DEPs. These proteins participate in biological activities such as inflammation, fibrosis, nerve growth and degeneration and metabolism. We found that the expression of transforming growth factor-β2 and matrilin2 was downregulated in the APAC group. The two proteins are related to inflammation and extracellular matrix formation, which might be involved in angle closure. This study characterized DEPs in AH of the APAC and found a downregulated protein matrilin2.
Topics: Humans; Acute Disease; Aqueous Humor; Cataract; Enzyme-Linked Immunosorbent Assay; Inflammation; Transforming Growth Factor beta2; Matrilin Proteins
PubMed: 38235996
DOI: 10.1111/jcmm.18111 -
Medicine Dec 2023To compare the effects of blue-light-filtering intraocular lenses (BF-IOLs) and conventional ultraviolet-blocking intraocular lenses (UVB-IOLs) on contrast sensitivity... (Comparative Study)
Comparative Study Randomized Controlled Trial
To compare the effects of blue-light-filtering intraocular lenses (BF-IOLs) and conventional ultraviolet-blocking intraocular lenses (UVB-IOLs) on contrast sensitivity in patients with concurrent cataracts and glaucoma. This prospective randomized comparative interventional study enrolled glaucomatous patients with concurrent cataracts scheduled for cataract surgery with IOL implantation at Siriraj Hospital, Bangkok, Thailand, between October 2016 and March 2018. The patients were randomly assigned to receive BF-IOLs or UVB-IOLs. A functional vision analyzer measured contrast sensitivity at spatial frequencies of 1.5, 3.0, 6.0, 12.0, and 18.0 cycles per degree (CPD). The contrast sensitivity values of the 2 patient groups were compared at 2 months postoperatively. The study enrolled 42 eyes (21 with primary angle-closure glaucoma and 21 with primary open-angle glaucoma) of 32 patients. Twenty eyes received BF-IOLs, and 22 received UVB-IOLs. Postoperative logarithmic contrast sensitivity (log contrast sensitivity) significantly improved at each spatial frequency in both groups, except for 1.5 CPD. The median postoperative log contrast sensitivity values for the spatial frequencies of 1.5, 3.0, 6.0, 12.0, and 18.0 CPD for the BF-IOL group were 1.6, 1.9, 1.8, 1.4, and 0.6, respectively, compared to 1.4, 1.8, 1.7, 1.2, and 0.8 for the UVB-IOL group. However, the 2 groups had no significant differences in log contrast sensitivity values at each spatial frequency (P = .20, .37, .30, .28, and .68, respectively). Cataract surgery with IOL implantation improved contrast sensitivity in glaucomatous patients. The BF-IOLs and UVB-IOLs showed no statistically significant difference in the postoperative contrast sensitivity achieved at each spatial frequency.
Topics: Humans; Cataract; Contrast Sensitivity; Glaucoma, Open-Angle; Lens Implantation, Intraocular; Lenses, Intraocular; Phacoemulsification; Prospective Studies; Prosthesis Design; Thailand
PubMed: 38206685
DOI: 10.1097/MD.0000000000036821 -
American Journal of Ophthalmology Case... Dec 2023Iridocorneal endothelial (ICE) syndrome may cause refractory glaucoma due to progressive synechial closure or membrane formation at the anterior chamber angle....
PURPOSE
Iridocorneal endothelial (ICE) syndrome may cause refractory glaucoma due to progressive synechial closure or membrane formation at the anterior chamber angle. Filtration surgeries are often required but are associated with a higher rate of surgical failure or complications than other types of glaucoma. Herein, we report a new and effective surgical procedure for glaucoma secondary to ICE syndrome: Ex-PRESS shunt combined with ab-interno peripheral iridectomy using a small-gauge vitreous cutter.
METHODS
Three patients with ICE syndrome who underwent surgery were included. Intraoperatively, an ab-interno peripheral iridectomy was performed using a small-gauge vitreous cutter through a corneal incision in the superior-nasal or superior-temporal quadrants to create space for the insertion of Ex-PRESS shunt free from the iris tissue. The shunt was inserted under the scleral flap. The first patient underwent combined cataract surgery, whereas patients 2 (pseudophakia) and 3 (phakia) underwent Ex-PRESS alone.
RESULTS
No intraoperative complications were observed. The intraocular pressure remained stable until the final postoperative visits at approximately 7, 4, and 1 year in Cases 1, 2, and 3, respectively. Case 2, with mild preoperative corneal edema due to graft failure in Descemet's stripping automated endothelial keratoplasty (DSAEK), underwent reDSAEK 6 months postoperatively.
CONCLUSIONS AND IMPORTANCE
Ex-PRESS shunt combined with ab-interno peripheral iridectomy using a small-gauge vitreous cutter may be a safe and effective surgical procedure in patients with ICE syndrome, regardless of the lens status.
PubMed: 38161521
DOI: 10.1016/j.ajoc.2023.101887 -
Toxins Nov 2023Snakebite-related fatalities disproportionately affect populations in impoverished socio-economic regions, marked by limited access to adequate healthcare and... (Review)
Review
Snakebite-related fatalities disproportionately affect populations in impoverished socio-economic regions, marked by limited access to adequate healthcare and constrained antivenom availability. Early medical intervention is pivotal in mitigating mortality and morbidity associated with snakebite envenoming (SBE). While clinical assessment remains fundamental in treating SBE, this review aims to spotlight objective parameters that could also affect outcomes. Selected studies that identify factors associated with poor outcomes are predominantly region-specific, single-site, and observational, yet collectively reveal similar findings. They consistently report factors such as treatment delays, susceptibility in vulnerable groups such as children and pregnant women, as well as various biochemical and haematological abnormalities. Acute kidney injury (AKI), low platelets, leucocytosis, abnormal coagulation, and elevated creatine kinase (CK) all show an association with poor outcomes. Furthermore, recognising rare and unusual SBE presentations such as adrenal insufficiency, severe hypertension, intracranial haemorrhage, acute angle closure glaucoma, and bowel ischaemia also has a bearing on outcomes. Despite the integration of these parameters into clinical decision tools and guidelines, the validation of this evidence is limited. This review underscores the imperative for high-quality, multi-centre studies aligned with consensus-driven Core Outcome Sets (COS) and Patient-Reported Outcome Measures (PROMS) to validate and strengthen the current evidence.
Topics: Pregnancy; Child; Animals; Humans; Female; Snake Bites; Antivenins; Snake Venoms; Snakes; Risk Factors
PubMed: 38133179
DOI: 10.3390/toxins15120675 -
Ophthalmic Research 2023The aim of the study was to investigate the clinical characteristics and treatment outcomes of the pseudophakic eyes with malignant glaucoma (MG).
INTRODUCTION
The aim of the study was to investigate the clinical characteristics and treatment outcomes of the pseudophakic eyes with malignant glaucoma (MG).
METHODS
This retrospective case-control study enrolled 53 eyes of 47 patients with primary angle-closure glaucoma having cataract surgery history, including 19 patients (25 eyes) diagnosed with MG and 28 patients (28 eyes) without MG as the match. Among patients diagnosed with MG, 14 patients (18 eyes) underwent zonulo-hyaloido-vitrectomy (ZHV) and the other 5 patients (7 eyes) received conservative treatments. The visual acuity, refraction status, intraocular pressure (IOP), extent of peripheral anterior synechia, classes of anti-glaucoma medications, and ultrasound biomicroscopy (UBM) examination were recorded before cataract surgery, at the diagnosis of MG, and 3 months after ZHV or atropine application, respectively.
RESULTS
In the pseudophakic eyes with MG, the IOP cannot be well controlled compared to the matched eyes (27.24 ± 8.72 mm Hg vs. 14.30 ± 2.63 mm Hg, p < 0.001). In addition, there was a difference in the average spherical equivalent refractive error between 2 groups of patients (-2.23 ± 0.84 D in MG vs. -0.12 ± 0.64 D in the matched eyes, p < 0.001). By UBM analysis, the anterior chamber depth (ACD) was shallower in MG than that in the matched eyes (2.34 ± 0.20 mm vs. 3.47 ± 0.29 mm, p < 0.001). The difference between the anterior vault distance of the pseudophakic eyes with MG and that of the matched eyes was also significant (p < 0.001). After treated with ZHV, the IOP was greatly decreased from 27.84 ± 10.14 mm Hg to 15.85 ± 4.41 mm Hg (p < 0.001). The refractive error also changed from -2.11 ± 0.91 D to +0.42 ± 0.99 D (p < 0.001). At the same time, the central ACD was significantly deepened from 2.30 ± 0.39 mm to 3.30 ± 0.31 mm (p < 0.001).
CONCLUSION
Uncontrolled IOP and shallow anterior chamber both centrally and peripherally are the primary clinical characteristics for the pseudophakic eyes with MG. An unexpected refractive error or myopic shift for the eyes with PACG after cataract surgery can be an important hint for diagnosis of MG. The typical UBM image is an anterior displacement of the lens-iris diaphragm and a bow-shaped change of the intraocular lens. It is an effective way to treat pseudophakic MG with the ZHV through a peripheral iridectomy.
Topics: Humans; Retrospective Studies; Case-Control Studies; Glaucoma, Angle-Closure; Glaucoma; Intraocular Pressure; Myopia; Cataract; Phacoemulsification
PubMed: 38130005
DOI: 10.1159/000533496 -
International Journal of Ophthalmology 2023To describe the outcome of using low-dose laser cycloplasty (LCP) in chronic angle-closure glaucoma (CACG).
AIM
To describe the outcome of using low-dose laser cycloplasty (LCP) in chronic angle-closure glaucoma (CACG).
METHODS
A retrospective case series. Medical charts of CACG patients who underwent LCP in the Eye Hospital of Wenzhou Medical University were reviewed. The main outcomes included intraocular pressure (IOP), the number of glaucoma medication, anterior segment parameters and surgery-related complications.
RESULTS
A total of 7 eyes of 7 CACG patients (age 38.9±11.0y) underwent LCP with a mean follow-up of 27.1±13.7mo (range 16-48mo). Following LCP, mean IOP and glaucoma medications decreased from 26.1±6.1 mm Hg with 3.1±1.1 glaucoma medications pre-treatment to 14.9±3.1 mm Hg (=0.027) with 0.4±1.1 glaucoma medications (=0.001) at final follow-up. The anterior chamber depth (ACD), angle opening distance and trabecular-iris angle increased from 1.65±0.33 mm, 0.05 mm (range 0-0.30 mm) and 5.1° (range, 0-31.97°) at baseline to 1.98±0.43 mm (=0.073), 0.53 mm (range 0.42-0.91 mm, =0.015), 45.9° (range, 40.2°-59.4°, (=0.015) in the long-term follow-up, respectively. The deepening of ACD and reopening of anterior chamber angle (ACA) was observed in 6 eyes (85.7%).
CONCLUSION
LCP is a promising treatment option for patients with CACG reducing IOP and glaucoma medication without serious complications. In addition, LCP can bring a significant deepening in ACD and reopening of ACA.
PubMed: 38111928
DOI: 10.18240/ijo.2023.12.13 -
Korean Journal of Ophthalmology : KJO Feb 2024To investigate the prevalence ratio of primary angle-closure glaucoma (PACG) and primary open-angle glaucoma (POAG) in the Asian population. (Meta-Analysis)
Meta-Analysis
PURPOSE
To investigate the prevalence ratio of primary angle-closure glaucoma (PACG) and primary open-angle glaucoma (POAG) in the Asian population.
METHODS
Systematic searches of PubMed, Embase, and Cochrane databases for population-based studies in Asia published until August 5, 2022. We conducted a meta-analysis for PACG to POAG prevalence ratio using inverse variance-weighted random-effects meta-analyses so as to combine the study-specific measures of association. Between-study outcome variation (i.e., heterogeneity) was quantified with the I2 statistic. The multiple meta-regression analyses were performed in order to further account for the reasons for heterogeneity.
RESULTS
Twenty studies, with a total study population of 52,522 individuals, had been conducted in 13 countries. The pooled PACG to POAG prevalence ratio was 2.204 (95% confidence interval, 1.617-3.004) with high heterogeneity (p < 0.001). In multiple meta-regression model, prevalence of POAG is the most important predictor for heterogeneity (model importance, 0.954), followed continent (0.508), and publication year (0.222). For every additional elevation of POAG prevalence (i.e., increase of 1.0%), the PACG to POAG prevalence ratio is expected to rise by 0.471.
CONCLUSIONS
We estimated the pooled PACG to POAG prevalence ratio in the Asian population. The POAG prevalence is the most important factor to determine the PACG to POAG prevalence ratio.
Topics: Humans; Glaucoma, Open-Angle; Glaucoma, Angle-Closure; Prevalence; Regression Analysis; Intraocular Pressure
PubMed: 38104594
DOI: 10.3341/kjo.2023.0057 -
Indian Journal of Ophthalmology Mar 2024The surgical intervention of refractory primary angle-closure glaucomas (PACGs) is a big challenge to any ophthalmologist since the efficacy of lens extraction in eyes...
BACKGROUND
The surgical intervention of refractory primary angle-closure glaucomas (PACGs) is a big challenge to any ophthalmologist since the efficacy of lens extraction in eyes with a long duration of angle closure is limited. Also, trabeculectomy in such eyes is not without vision-threatening complications.
PURPOSE
To evaluate the efficacy and safety of diode laser transscleral cyclophotocoagulation (CPC) in eyes with refractory PACG.
METHODS
A retrospective study analyzing all patients who underwent CPC for refractory PACG in the year 2019 was conducted. Out of the 68 patients recruited, 56 PACG patients fulfilled the study criteria.
RESULTS
The mean age of the participants was 58.5 years. The mean (standard deviation [SD]) intraocular pressure (IOP) at baseline was 38.91 (14.86) mmHg, and it ranged from 21 to 74 mmHg. Participants' mean (SD) follow-up duration was 11.87 (7.83) months. Almost 90.9% of eyes showed IOP reduction from baseline during the follow-up period. There was also a reduction in the mean antiglaucoma medications (AGM) to 2.67 (1.29) in the final follow-up visit compared to the baseline of 3.30 (0.81). Chronic hypotony was noted in four eyes, out of which phthisis bulbi occurred in one eye. Six eyes underwent additional incisional surgical procedures.
CONCLUSION
The outcomes from our study support the role of transscleral diode laser CPC in the interim optimization of IOP in PACG eyes refractory to other modalities. This is emerging as a primary treatment option to optimize IOP to safer limits before any planned incisional procedure. Though complications like chronic hypotony occur as anticipated, vision-threatening complications are rare.
Topics: Humans; Middle Aged; Glaucoma, Angle-Closure; Retrospective Studies; Lasers, Semiconductor; Treatment Outcome; Laser Coagulation; Visual Acuity; Ciliary Body; Intraocular Pressure
PubMed: 38099577
DOI: 10.4103/IJO.IJO_1129_23