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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 -
Cost-Utility Analysis of Prophylactic Laser Peripheral Iridotomy for Primary Angle Closure Suspects.American Journal of Ophthalmology Apr 2024To assess the cost-utility of prophylactic laser peripheral iridotomy (LPI) for primary angle closure (PAC) suspects (PACS).
PURPOSE
To assess the cost-utility of prophylactic laser peripheral iridotomy (LPI) for primary angle closure (PAC) suspects (PACS).
DESIGN
Economic evaluation.
METHODS
Our Markov model randomized PACS eyes to LPI or observation for 40 one-year cycles (100,000 iterations per strategy). Each cycle, an eye remained in its current health state, advanced linearly through PAC, mild, moderate, severe, and end-stage PAC glaucoma (PACG), or died. Transition rates were derived from the literature including the Zhongshan Angle Closure Prevention (ZAP) trial and the Singapore Asymptomatic Narrow Angles Laser Iridotomy Study (ANA-LIS). Eyes with acute-angle closure advanced to either PAC or directly to various PACG severities. A tracker monitored accumulated perimetric decibel reduction to progress PACG through increasing severities, with an annual probability of either stable or severity-dependent perimetry loss. We set a willingness to pay of an incremental cost-effectiveness ratio (ICER) <$50,000/quality-adjusted life-years.
RESULTS
At age 50 years, LPI was cost-saving using ZAP data and cost-effective using ANA-LIS data. The ZAP iterations became cost-effective from the societal perspective when the model started at age 55 years and third-party perspective at age 70 years. LPI was no longer cost-effective from the societal perspective using ANA-LIS data at age 80 years or from the societal perspective using ZAP data or third-party perspective with ANA-LIS data at age 85. Probabilistic sensitivity analyses favored LPI until starting age 85.
CONCLUSIONS
Prophylactic LPI for PACS is cost-effective across a spectrum of ages and should be considered from a public health perspective.
PubMed: 38648872
DOI: 10.1016/j.ajo.2024.04.011 -
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 -
Problemy Sotsial'noi Gigieny,... Mar 2024According to world forecasting, the number of patients with glaucoma all over the world will reach 111.8 million up to 2040 . The percentage of primary open-angle...
According to world forecasting, the number of patients with glaucoma all over the world will reach 111.8 million up to 2040 . The percentage of primary open-angle glaucoma is 2.34% and primary closed-angle glaucoma is 0.73%. According to mathematical forecast, further increasing of common and primary morbidity is expected. The retrospective analysis of patient records of the Department of Eye Microsurgery № 2 of the National Hospital of the Ministry of Health of the Kyrgyz Republic was carried out. It is established that among total number of treated patients with glaucoma, no significant difference in rate of cases of closed-angle (53,7±1,7) and open-angle forms (46,3±1,7) was established. In most cases, open-angle glaucoma was diagnosed in age group of 60-79 years and closed-angle glaucoma in age group of 50-79 years. The women are reliably more often suffer of glaucoma. The majority of patients had stage III (42,3±2,5), stage II (31,8±2,4) and stage I (22,2±2,1). At all stages, women more often had glaucoma with the exception of stage III and IV that were diagnosed with same rate were diagnosed in patients of both sexes. Unfortunately, there were isolated cases of open-angle glaucoma at young age. The results of the study dictate importance of prevention, early diagnostic, treatment and rehabilitation of ophthalmologic patients.
Topics: Male; Humans; Female; Middle Aged; Aged; Glaucoma, Open-Angle; Glaucoma, Angle-Closure; Retrospective Studies; Kyrgyzstan; Intraocular Pressure; Glaucoma
PubMed: 38640221
DOI: 10.32687/0869-866X-2024-32-2-252-256 -
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 -
European Journal of Ophthalmology Apr 2024To study response to water drinking provocation in primary open angle glaucoma (POAG), ocular hypertensives and glaucoma suspects and establish the role of water...
PURPOSE
To study response to water drinking provocation in primary open angle glaucoma (POAG), ocular hypertensives and glaucoma suspects and establish the role of water drinking provocation test (WDPT) as a relevant supplementary tool in glaucoma management.
MATERIALS AND METHODS
319 eyes of 161 patients were included in the study after retrospectively analyzing hospital records of patients who underwent WDPT. The patients were categorized into Group A (POAG on treatment), Group B (treatment-naïve POAG), Group C (Ocular hypertensives), Group D (glaucoma suspects). All patients were asked to drink 1 liter of water within 5 min and intraocular pressures (IOP) were recorded after 20 and 30 min of water intake. The baseline, peak and IOP fluctuation were analysed. A fluctuation of ≥ 5 mm Hg was considered positive response.
RESULTS
19 eyes were categorized as Group A, 58 as Group B, 96 and 146 eyes as groups C and D respectively. Baseline IOP in different groups differed significantly. Mean peak IOP was higher in Groups B and C, followed by Groups A and D. Mean IOP fluctuation differed significantly across groups being maximum in Group A (7.0 ± 2.5) and minimum in Group D (4.8 ± 2.9). Positive WDPT response was seen in 89.5% eyes in Group A, 77.6% of those in Group B, 55.2% and 48.6% in Groups C and D respectively. The baseline IOP had a significant positive correlation with the peak IOP across all groups.
CONCLUSION
The WDPT is an inexpensive practical tool which serves as an invaluable aid in glaucoma management.
PubMed: 38629148
DOI: 10.1177/11206721241248215 -
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