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Balci AS, Cakir I, Altan C. Optic Nerve Head, Peripapillary and Macular Microvascular Characteristics in Patients With Unilateral Pseudoexfoliation Glaucoma. J Glaucoma 2023; 32:989-997. [PMID: 37523619 DOI: 10.1097/ijg.0000000000002265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 07/08/2023] [Indexed: 08/02/2023]
Abstract
PRCIS In unilateral pseudoexfoliation glaucoma (PEXG), there may be decreased choroidal vascularity index (CVI), radial peripapillary capillary plexus' perfusion and flow. CVI may also be reduced in fellow eyes, suggesting that PEXG is bilateral disease. PURPOSE Evaluation of peripapillary and macular choroidal microvascularity and radial peripapillary capillary plexus in both eyes with unilateral PEXG and healthy eyes. MATERIALS AND METHODS Ninety-six eyes of 48 patients with unilateral PEXG [PEX (+): 48 eyes with PEXG; PEX (-): 48 eyes without PEX] and the right eyes of 45 age- and sex-matched healthy controls were included in the study. CVI was calculated on enhanced depth imaging optical coherence tomography scans. Radial peripapillary capillary vascular layer were evaluated by OCT-angiography. RESULTS Macular CVI (mCVI), temporal and nasal peripapillary CVI (pCVI) was significantly decreased in the PEX (+) compared with the PEX (-) and control group ( P <0.05 for all). Although there was a significant difference between PEX (-) and the control group in terms of mCVI and temporal pCVI, there was no significant difference between the 2 groups in terms of nasal pCVI ( P =0.008, P =0.036, and P =0.604, respectively). There was a significant difference in perfusion density (PD) and flux index (FI) between PEX (+) group, PEX (-) group and control group in all quadrants and average value ( P <0.05 for all). Although the PD and FI values in all quadrants and average values of the PEX (-) group were lower than the control group, this difference was not significant. CONCLUSIONS CVI in the macula and peripapillary region was significantly decreased in eyes with PEXG. Similarly, PD and FI were lower in eyes with PEXG. Low mCVI and temporal pCVI can also be seen in eyes without PEX.
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Affiliation(s)
- Ali Safa Balci
- University of Health Sciences Turkey, Beyoglu Eye Training and Research Hospital, Beyoglu, Istanbul, Turkey
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Lauwers A, Barbosa Breda J, Stalmans I. The natural history of untreated ocular hypertension and glaucoma. Surv Ophthalmol 2022; 68:388-424. [PMID: 36563707 DOI: 10.1016/j.survophthal.2022.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Revised: 12/07/2022] [Accepted: 12/12/2022] [Indexed: 12/25/2022]
Abstract
Glaucoma is a chronic, progressive disease leading to irreversible blindness if left untreated; however, since reducing intraocular pressure has proven to be successful in slowing disease progression, little is known about the natural history of untreated glaucoma. This knowledge can be valuable in guiding management decisions in the era of personalized medicine. A systematic search was performed in Medline (PubMed), Embase, and Web of Science in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRIMSA) guidelines. The rate of structural and/or functional progression and conversion to glaucoma or to a more advanced stage of glaucoma are discussed for ocular hypertension and different types of open-angle glaucoma. Forty-three studies were included. Different rates of progression were found both among and within the different diagnostic groups that belong to the open-angle glaucoma spectrum. The highest rate was found in pseudoexfoliation glaucoma, followed by high tension glaucoma, normal tension glaucoma, and ocular hypertension, in decreasing order. The lowest rate was observed in glaucoma suspects. The known rates of progression provide valuable prognostic information for ophthalmologists and patients. Nonetheless, due to high variability among patients, individual progression cannot be accurately predicted and repeated follow-up examinations are required to estimate individual progression.
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Affiliation(s)
- Amelien Lauwers
- Department of Ophthalmology, Faculty of Medicine, University Hospitals Leuven, 3000 Leuven, Belgium
| | - João Barbosa Breda
- Research Group Ophthalmology, Department of Neurosciences, KU Leuven, 3000 Leuven, Belgium; Department of Ophthalmology, Centro Hospitalar e Universitário São João, 4200-319 Porto, Portugal; Cardiovascular R&D Centre - UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, 4200-319 Porto, Portugal.
| | - Ingeborg Stalmans
- Research Group Ophthalmology, Department of Neurosciences, KU Leuven, 3000 Leuven, Belgium; Department of Ophthalmology, University Hospitals Leuven, 3000 Leuven, Belgium
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Ozcelik-Kose A, Yıldız MB, Imamoglu S. Diagnostic Performance of Optical Coherence Tomography for Pseudoexfoliation Glaucoma. J Glaucoma 2022; 31:651-658. [PMID: 35474292 DOI: 10.1097/ijg.0000000000002042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 04/15/2022] [Indexed: 11/25/2022]
Abstract
PRECIS LC thickness and LCCI had comparable diagnostic performances with RNFL thickness in distinguishing eyes with PXG from those with PXS. BMO-MRW showed the lowest diagnostic performance among all geometric parameters derived from OCT scans we evaluated. OBJECTIVE To compare the diagnostic performance of different geometric parameters derived from optical coherence tomography (OCT) scans (retinal nerve fiber layer [RNFL] thickness, lamina cribrosa [LC] thickness, LC curvature index [LCCI] and Bruch's membrane opening-minimum rim width [BMO-MRW]) for distinguishing eyes with pseudoexfoliation glaucoma (PXG) from pseudoexfoliation syndrome (PXS) and healthy eyes. METHODS Fifty-five eyes of 55 patients with PXG, 55 eyes of 55 patients with PXS, and 50 healthy subjects were enrolled in this cross-sectional study. The areas under the receiver operating characteristic curves (AUCs) of RNFL thickness, LC thickness, LCCI and BMO-MRW were calculated and compared. RESULTS In discriminating between eyes with PXG from those with PXS, LC thickness (0.930 [95% CI: 0.883-0.978]) and global RNFL thickness (0.974 [95% CI: 0.947-0.992]) presented comparable AUCs (P=0.244). In distinguishing subjects wiht PXG from healthy controls, both LC thickness (0.972 [95% CI: 0.948-0.997]) and LCCI (0.983 [95% CI: 0.968-0.998]) had comparable AUCs with global RNFL thickness (0.988 [95% CI: 0.974-1.000]) (P=0.094 andP=0.239, respectively). Global BMO-MRW had lower AUCs than RNFL thickness (0.839 [95% CI: 0.759-0.920] and 0.897 [95% CI: 0.836-0.958], respectively) in distinguishing PXG from both PXS and healthy controls (P=0.001 andP=0.002, respectively). BMO-MRW also had significantly lower AUCs than both LC thickness and LCCI in distinguishing PXG from healthy controls (P=0.034 andP=0.001, respectively). CONCLUSION LC thickness and LCCI had better diagnostic performance than BMO-MRW in distinguishing PXG from PXS and healthy controls, which were comparable to RNFL thickness.
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Affiliation(s)
- Alev Ozcelik-Kose
- University of Health Sciences Haydarpasa Education and Research Hospital, Department of Ophthalmology, Istanbul, Turkey
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Greslechner R, Helbig H, Spiegel D. [Secondary open-angle glaucoma: pseudoexfoliative glaucoma, pigmentary glaucoma and neovascular glaucoma]. Ophthalmologe 2022; 119:425-438. [PMID: 35362756 DOI: 10.1007/s00347-022-01609-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2022] [Indexed: 11/30/2022]
Abstract
Secondary open-angle glaucomas are a heterogeneous group of diseases in which a variety of pathophysiological mechanisms result in an elevation of intraocular pressure. This article is the first part of a review of the more common forms of secondary open-angle glaucomas. The pathogenesis, characteristic clinical findings and treatment of pseudoexfoliative glaucoma, pigmentary glaucoma and neovascular glaucoma are discussed. An emphasis is placed on the differences in treatment compared to primary open-angle glaucoma and prophylactic treatment approaches are explained where possible.
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Affiliation(s)
- Roman Greslechner
- Klinik und Poliklinik für Augenheilkunde, Universitätsklinikum Regensburg, Regensburg, Deutschland.
| | - Horst Helbig
- Klinik und Poliklinik für Augenheilkunde, Universitätsklinikum Regensburg, Regensburg, Deutschland
| | - Detlev Spiegel
- Klinik und Poliklinik für Augenheilkunde, Universitätsklinikum Regensburg, Regensburg, Deutschland.,Augenzentrum München Süd, München, Deutschland
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Iwasaki K, Kakimoto H, Orii Y, Arimura S, Takamura Y, Inatani M. Long-Term Outcomes of a Kahook Dual Blade Procedure Combined with Phacoemulsification in Japanese Patients with Open-Angle Glaucoma. J Clin Med 2022; 11:jcm11051354. [PMID: 35268445 PMCID: PMC8910915 DOI: 10.3390/jcm11051354] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 02/22/2022] [Accepted: 02/28/2022] [Indexed: 12/12/2022] Open
Abstract
We retrospectively evaluated the long-term surgical outcomes of phacoemulsification combined with a Kahook dual blade (KDB) procedure in Japanese patients with open-angle glaucoma. The primary outcome was surgical success or failure. Surgical failure was indicated by a <20% reduction in preoperative intraocular pressure (IOP) or IOP > 18 mmHg (criterion A), IOP > 14 mmHg (criterion B), or requirement for reoperation. Glaucoma medications after surgery and postoperative complications were recorded. Surgical outcomes were compared between primary open-angle glaucoma (POAG) and exfoliation glaucoma (ExG) groups. The probability of success at 36 months postoperation was 52.5% using criterion A and 36.9% using criterion B. Mean IOP decreased significantly from 19.5 ± 6.9 mmHg preoperatively to 11.9 ± 2.7 mmHg at 36 months, and the mean number of glaucoma medications from 2.4 ± 1.4 to 1.6 ± 1.4 (both p < 0.01). IOP spikes were significantly more common in the ExG group (23.7% vs. 9.1%; p = 0.045), as was the need for additional glaucoma surgery (10.5% vs. 1.8%; p = 0.038). A KDB procedure combined with cataract surgery resulted in significant long-term decreases in IOP and the number of glaucoma medications. The complication rate was higher in eyes with ExG. Therefore, these eyes require more careful management after a KDB procedure.
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Affiliation(s)
- Kentaro Iwasaki
- Department of Ophthalmology, Faculty of Medical Sciences, University of Fukui, Fukui 910-1193, Japan; (K.I.); (Y.O.); (S.A.); (Y.T.)
| | - Hiroshi Kakimoto
- Department of Ophthalmology, Obama Hospital, Fukui 917-0078, Japan;
| | - Yusuke Orii
- Department of Ophthalmology, Faculty of Medical Sciences, University of Fukui, Fukui 910-1193, Japan; (K.I.); (Y.O.); (S.A.); (Y.T.)
| | - Shogo Arimura
- Department of Ophthalmology, Faculty of Medical Sciences, University of Fukui, Fukui 910-1193, Japan; (K.I.); (Y.O.); (S.A.); (Y.T.)
| | - Yoshihiro Takamura
- Department of Ophthalmology, Faculty of Medical Sciences, University of Fukui, Fukui 910-1193, Japan; (K.I.); (Y.O.); (S.A.); (Y.T.)
| | - Masaru Inatani
- Department of Ophthalmology, Faculty of Medical Sciences, University of Fukui, Fukui 910-1193, Japan; (K.I.); (Y.O.); (S.A.); (Y.T.)
- Department of Ophthalmology, Obama Hospital, Fukui 917-0078, Japan;
- Correspondence: ; Tel.: +81-776-61-8400
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Hepokur M, Elgin CY, Gunes M, Sali F, Oguz H. A comprehensive enhanced depth imaging spectral-domain optical coherence tomography analysis of pseudoexfoliation spectrum from non-glaucomatous to advanced stage glaucoma in the aspect of Bruch's membrane opening-minimum rim width. Int Ophthalmol 2022; 42:1835-1847. [PMID: 34984628 DOI: 10.1007/s10792-021-02181-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 12/18/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE To compare the correlations between lamina cribrosa (LC) and related structures with Bruch's membrane opening-minimum rim width (BMO-MRW) and retinal nerve fiber layer (RNFL) thickness in pseudoexfoliation syndrome (PXS) and different stages of pseudoexfoliation glaucoma (PXG). METHODS This prospective cross-sectional study included 32 PXS eyes of 24 patients and 94 PXG eyes (early-stage (n: 55) and advanced-stage glaucoma (n: 39) of 78 patients. Global and six sectors of RNFL thicknesses and BMO-MRW parameters were measured with enhanced depth imaging (EDI) mode of SD-OCT. Structural parameters; lamina cribrosa thickness (LCT), lamina cribrosa depth (LCD), prelaminar tissue thickness (PLTT), four quadrants of peripapillary choroidal thicknesses (PPCT), and subfoveal choroidal thickness (SFCT) were measured and statistical relationships between the structural parameters have been laid out. We apply the generalized estimating equations method to take into account dependency of right and left eyes. RESULTS From PXS to mild and advanced PXG groups LCT and PLTT decrease from 147.29 ± 33.10, 145.62 ± 30.64, 126.30 ± 29.14 and 260.93 ± 185.07, 247.27 ± 142.58, 159.89 ± 86.84, respectively, and LCD varies as 159.89 ± 86.84, 420.88 ± 117.80, and 505.64 ± 183.25. The correlations between LCD, LCT, and PLTT and the stage of the disease are significant. BMO-MRW shows slightly stronger correlations than the RNFL with LC related parameters. SFCT does not exhibit any significant relationship with the stage of the disease. However, PPCT in only the interior quadrant does. The significant correlations between LCD and all quadrants of PPCT is the sign of important anatomic relationship. CONCLUSION These findings show that the BMO-MRW parameter may be more sensitive than RNFL and can safely be used in the diagnosis and follow-up in PXS and PXG, but this result should be supported with longer and larger series.
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Affiliation(s)
- Mustafa Hepokur
- Department of Ophthalmology, Istanbul University-Cerrahpasa, Cerrahpasa School of Medicine, Istanbul, Turkey
| | - Cansu Yuksel Elgin
- Department of Ophthalmology, Istanbul University-Cerrahpasa, Cerrahpasa School of Medicine, Istanbul, Turkey.
| | - Medine Gunes
- Department of Ophthalmology, Göztepe Prof. Dr. Süleyman Yalçın City Hospital, Istanbul, Turkey.,Department of Ophthalmology, Istanbul Medeniyet University Medical Faculty, Istanbul, Turkey
| | - Fatma Sali
- Department of Ophthalmology, Göztepe Prof. Dr. Süleyman Yalçın City Hospital, Istanbul, Turkey.,Department of Ophthalmology, Istanbul Medeniyet University Medical Faculty, Istanbul, Turkey
| | - Halit Oguz
- Department of Ophthalmology, Göztepe Prof. Dr. Süleyman Yalçın City Hospital, Istanbul, Turkey.,Department of Ophthalmology, Istanbul Medeniyet University Medical Faculty, Istanbul, Turkey
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Koklesova L, Mazurakova A, Samec M, Biringer K, Samuel SM, Büsselberg D, Kubatka P, Golubnitschaja O. Homocysteine metabolism as the target for predictive medical approach, disease prevention, prognosis, and treatments tailored to the person. EPMA J 2021; 12:477-505. [PMID: 34786033 PMCID: PMC8581606 DOI: 10.1007/s13167-021-00263-0] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 10/29/2021] [Indexed: 02/07/2023]
Abstract
Homocysteine (Hcy) metabolism is crucial for regulating methionine availability, protein homeostasis, and DNA-methylation presenting, therefore, key pathways in post-genomic and epigenetic regulation mechanisms. Consequently, impaired Hcy metabolism leading to elevated concentrations of Hcy in the blood plasma (hyperhomocysteinemia) is linked to the overproduction of free radicals, induced oxidative stress, mitochondrial impairments, systemic inflammation and increased risks of eye disorders, coronary artery diseases, atherosclerosis, myocardial infarction, ischemic stroke, thrombotic events, cancer development and progression, osteoporosis, neurodegenerative disorders, pregnancy complications, delayed healing processes, and poor COVID-19 outcomes, among others. This review focuses on the homocysteine metabolism impairments relevant for various pathological conditions. Innovative strategies in the framework of 3P medicine consider Hcy metabolic pathways as the specific target for in vitro diagnostics, predictive medical approaches, cost-effective preventive measures, and optimized treatments tailored to the individualized patient profiles in primary, secondary, and tertiary care.
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Affiliation(s)
- Lenka Koklesova
- Clinic of Obstetrics and Gynecology, Jessenius Faculty of Medicine, Comenius University in Bratislava, 036 01 Martin, Slovakia
| | - Alena Mazurakova
- Clinic of Obstetrics and Gynecology, Jessenius Faculty of Medicine, Comenius University in Bratislava, 036 01 Martin, Slovakia
| | - Marek Samec
- Jessenius Faculty of Medicine in Martin, Biomedical Centre Martin, Comenius University in Bratislava, Mala Hora 4D, 036 01 Martin, Slovakia
| | - Kamil Biringer
- Clinic of Obstetrics and Gynecology, Jessenius Faculty of Medicine, Comenius University in Bratislava, 036 01 Martin, Slovakia
| | - Samson Mathews Samuel
- Department of Physiology and Biophysics, Weill Cornell Medicine in Qatar, Education City, Qatar Foundation, 24144 Doha, Qatar
| | - Dietrich Büsselberg
- Department of Physiology and Biophysics, Weill Cornell Medicine in Qatar, Education City, Qatar Foundation, 24144 Doha, Qatar
| | - Peter Kubatka
- Department of Medical Biology, Jessenius Faculty of Medicine, Comenius University in Bratislava, 036 01 Martin, Slovakia
| | - Olga Golubnitschaja
- Predictive, Preventive, Personalised (3P) Medicine, Department of Radiation Oncology, University Hospital Bonn, Rheinische Friedrich-Wilhelms-Universität Bonn, 53127 Bonn, Germany
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8
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Founti P, Coleman AL, Wilson MR, Yu F, Harris A, Pappas T, Anastasopoulos E, Koskosas A, Salonikiou A, Keskini C, Malamas A, Kilintzis V, Raptou A, Tzoanou G, Topouzis F. Twelve-Year Incidence of Open-angle Glaucoma: The Thessaloniki Eye Study. J Glaucoma 2021; 30:851-858. [PMID: 34127627 DOI: 10.1097/ijg.0000000000001899] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 05/23/2021] [Indexed: 02/07/2023]
Abstract
OBJECTIVE The objective of this study was to determine the 12-year incidence of open-angle glaucoma (OAG), with further classification into primary open-angle glaucoma (POAG) and pseudoexfoliative glaucoma (PEXG), in an elderly White population. DESIGN A longitudinal, population-based study in urban Northern Greece. PARTICIPANT Surviving cohort of the 2554 Thessaloniki Eye Study subjects 60 years and above who had the baseline examination. METHODS The surviving cohort was re-examined 12 years after baseline, using the same methodology and the same standard operating procedures as in the baseline examination. The definitions of glaucoma and pseudoexfoliation were consistent throughout the study. The 12-year incidences of OAG, POAG, and PEXG with corresponding 95% confidence intervals (CIs) were calculated for the whole study population, consisting of clinic-visit and home-visit participants. The population at risk was defined as those who did not meet the study criteria for the diagnosis of glaucoma in either eye at baseline. MAIN OUTCOME MEASURES Twelve-year incidence of OAG, with further classification into POAG and PEXG. RESULTS Of 1468 eligible subjects in the surviving cohort, 1092 were examined (participation rate 74%). Mean age at baseline was 68.9±4.6 years. Mean follow-up time was 11.6±1.6 years. The 12-year incidence of OAG was 4.4% (95% CI: 3.3-5.8); 0.37% per year. In the overall population the incidence of POAG and PEXG was 2.1% (95% CI: 1.3-3.2) and 2.3% (95% CI: 1.5-3.4), respectively. The corresponding incidence proportions were 2.9 (95% CI: 1.8-4.3) in those without PEX and 8.9 (95% CI: 5.8-12.9) in those with PEX at baseline and/or incidence. The latter was strongly associated with higher odds for incident glaucoma (odds ratio=3.34, 95% CI: 1.83-6.08, P<0.001). Of all incident OAG cases, 11.1% (95% CI: 4.4-24) had baseline intraocular pressure >21 mm Hg. CONCLUSIONS The incidence of OAG was similar or higher compared with other White populations. The incidence of glaucoma in those with PEX was higher compared with the incidence of glaucoma in those without PEX.
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Affiliation(s)
- Panayiota Founti
- Glaucoma Unit, Moorfields Eye Hospital NHS Foundation Trust, London, UK
- Department of Ophthalmology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Anne L Coleman
- Stein Eye Institute, David Geffen School of Medicine
- Departments of Epidemiology
| | | | - Fei Yu
- Stein Eye Institute, David Geffen School of Medicine
- Biostatistics, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA
| | - Alon Harris
- Icahn School of Medicine at Mount Sinai, New York, NY
| | - Theofanis Pappas
- Department of Ophthalmology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Eleftherios Anastasopoulos
- Department of Ophthalmology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Archimidis Koskosas
- Department of Ophthalmology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Angeliki Salonikiou
- Department of Ophthalmology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Christina Keskini
- Department of Ophthalmology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Angelakis Malamas
- Department of Ophthalmology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Vassilis Kilintzis
- Department of Ophthalmology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Anastasia Raptou
- Department of Ophthalmology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Grigoria Tzoanou
- Department of Ophthalmology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Fotis Topouzis
- Department of Ophthalmology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Firat PG, Dikci S, Firat İT, Demirel S, Firat M, Öztürk E, Gök ZE. Correlation between intraocular pressure obtained with water drinking test versus modified diurnal tension curve measurement in pseudoexfoliation glaucoma. Int Ophthalmol 2021; 41:2879-2886. [PMID: 33877501 DOI: 10.1007/s10792-021-01847-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 04/08/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE The aim of this paper was to study the correlation and agreement between the intraocular pressure (IOP) peak value and fluctuations detected with the modified diurnal tension curve (mDTC) and the water drinking test (WDT) in pseudoexfoliation glaucoma (XFG) patients. METHODS This prospective observational study enrolled 42 eyes of 42 XFG patients. The IOPs were measured at 2-h intervals from 8 am to 4 pm with a Goldmann applanation tonometer by a single observer to establish the mDTC. The WDT was then performed between 4 and 5 pm on the same day and the IOP was measured 4 times at 15-min intervals after water ingestion. The IOPpeak, IOPmean, IO min, and IOPfluctuation were measured with both the mDTC and WDT. The paired sample t test, Spearman's correlation coefficient and Bland-Altman plots were used for statistical analysis. RESULTS The mean age of the 42 patients consisting of 24 females and 18 males was 66.9 ± 6.8 years, and the mean central corneal thickness was 517.7 ± 29.1 µm. The mean values with the mDTC and WDT measurements were 15.05 ± 2.75 mmHg and 17.17 ± 3.25 mmHg (p ≤ 0.0001, r = 0.884) for IOPmean, 16.76 ± 3.45 mmHg and 18.92 ± 3.94 mmHg (p ≤ 0.0001, r=0.787) for IOPpeak, and 13.61 ± 2.56 mmHg and 15.11 ± 2.84 mmHg (p ≤ 0.0001, r=0.824) for IOPmin, respectively, and a positive correlation was present between these values. CONCLUSION There was a positive correlation between the peak, minimum, and mean IOP values determined using the mDTC and WDT in treated XFG patients. WDT can be used as an alternative in the assessment of the IOP in these patients as a more practical method.
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Affiliation(s)
- Penpe Gül Firat
- Department of Ophthalmology, Inonu University School of Medicine, TR-44280, Malatya, Turkey.
| | - Seyhan Dikci
- Department of Ophthalmology, Inonu University School of Medicine, TR-44280, Malatya, Turkey
| | | | | | - Murat Firat
- Department of Ophthalmology, Elbistan State Hospital, Kahramanmaraş, Turkey
| | - Emrah Öztürk
- Department of Ophthalmology, Malatya State Hospital, Malatya, Turkey
| | - Zarife Ekici Gök
- Department of Ophthalmology, Malatya State Hospital, Malatya, Turkey
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10
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Gillmann K, Meduri E, Niegowski LJ, Mermoud A. Surgical Management of Pseudoexfoliative Glaucoma: A Review of Current Clinical Considerations and Surgical Outcomes. J Glaucoma 2021; 30:e32-e39. [PMID: 33137018 DOI: 10.1097/ijg.0000000000001724] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 10/19/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Pseudoexfoliative glaucoma (PEXG) is the most common cause of secondary open-angle glaucoma worldwide. It is more aggressive and often more resistant to conventional treatments than primary open-angle glaucoma, yet there is currently no clear consensus on best management practices. This review explores current literature on PEXG to assess the safety and efficacy of currently available surgical techniques, and discusses clinical considerations on the diagnosis and management of the disease. METHODS A PubMed and Google Scholar search identified 2271 articles. These were reviewed to exclude irrelevant or duplicate data. A total of 47 studies reporting specifically on PEXG were retained and analyzed. REVIEW One of the most significant ophthalmic consequences of pseudoexfoliative (PEX) syndrome is the compromising of the blood-aqueous barrier resulting in the leakage of inflammatory cytokines and extracellular matrix material into the anterior chamber. Considering the high risk of developing PEXG and the aggressive nature of this type of glaucoma, accurate and timely diagnosis of PEX is critical. Therefore, systematic attentive examination for PEX deposits is crucial. Patients diagnosed with PEX need frequent glaucoma assessments. Patient information is key to improving compliance. Gonioscopy and diurnal tension curves or 24-hour intraocular pressure (IOP) monitoring are integral part of the diagnostic work-up and risk-assessment of PEXG. Because of the lability of IOP in PEX, clinical decisions on the basis of single IOP measurements should be avoided. Cataract extraction was shown to provide persistent IOP-lowering effect in the order of 10% in PEXG. A number of other surgical options may offer wider IOP reduction, and both XEN 45 gel stents and angle-based glaucoma procedures were suggested to achieve better outcomes in PEXG than in primary open-angle glaucoma. Yet, more significant IOP reductions may be achieved with filtering surgery or glaucoma drainage device. Same day postoperative IOP monitoring is recommended to treat the frequent IOP spikes following surgery, and more aggressive anti-inflammatory therapy may reduce the rates of postoperative adverse events in PEXG. CONCLUSION Specific studies of the surgical management of PEXG remain scarce in the medical literature, and more long-term and comparative studies are warranted to define more robust recommendations.
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Affiliation(s)
- Kevin Gillmann
- Glaucoma Research Center, Montchoisi Clinic, Swiss Visio Network, Lausanne, Switzerland
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Influence of Circadian Rhythm in the Eye: Significance of Melatonin in Glaucoma. Biomolecules 2021; 11:biom11030340. [PMID: 33668357 PMCID: PMC7996162 DOI: 10.3390/biom11030340] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Revised: 02/19/2021] [Accepted: 02/20/2021] [Indexed: 02/07/2023] Open
Abstract
Circadian rhythm and the molecules involved in it, such as melanopsin and melatonin, play an important role in the eye to regulate the homeostasis and even to treat some ocular conditions. As a result, many ocular pathologies like dry eye, corneal wound healing, cataracts, myopia, retinal diseases, and glaucoma are affected by this cycle. This review will summarize the current scientific literature about the influence of circadian patterns on the eye, focusing on its relationship with increased intraocular pressure (IOP) fluctuations and glaucoma. Regarding treatments, two ways should be studied: the first one, to analyze if some treatments could improve their effect on the ocular disease when their posology is established in function of circadian patterns, and the second one, to evaluate new drugs to treat eye pathologies related to the circadian rhythm, as it has been stated with melatonin or its analogs, that not only could be used as the main treatment but as coadjutant, improving the circadian pattern or its antioxidant and antiangiogenic properties.
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Omoto T, Sugiura A, Fujishiro T, Asano-Shimizu K, Sugimoto K, Sakata R, Murata H, Asaoka R, Honjo M, Aihara M. Twelve-month surgical outcome and prognostic factors of stand-alone ab interno trabeculotomy in Japanese patients with open-angle glaucoma. PLoS One 2021; 16:e0245015. [PMID: 33411802 PMCID: PMC7790371 DOI: 10.1371/journal.pone.0245015] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 12/20/2020] [Indexed: 11/29/2022] Open
Abstract
The purpose of the study was to evaluate the 12-month surgical outcome and prognostic factors of stand-alone ab interno trabeculotomy. The changes in the intraocular pressure (IOP) and medication score and the success rate of the surgery were analyzed. Thirty-four eyes of 29 patients with primary open-angle glaucoma (POAG; n = 16) or pseudoexfoliation glaucoma (PEG; n = 18) with a 12-month follow-up period were included in the study. The decreases in IOP and medication score from the baseline to the all-time-point were statistically significant (P < 0.001). The surgical success rates were 97.1%, 76.5%, and 44.0% at 3 months (90 days), 6 months (180 days), and 12 months (365 days), respectively. A mixed effect Cox model revealed that the type of glaucoma (POAG) was significantly associated with surgical failure (P = 0.044). Furthermore, the surgical success rate was significantly higher in eyes with PEG than it was in those with POAG (P = 0.019). Stand-alone ab interno trabeculotomy significantly lowered both the IOP and the medication score in patients with glaucoma, although almost one quarter of the cases needed additional glaucoma surgeries. The surgical success rate was significantly higher in eyes with PEG than it was in those with POAG.
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Affiliation(s)
- Takashi Omoto
- Department of Ophthalmology, University of Tokyo Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan
| | - Aya Sugiura
- Department of Ophthalmology, University of Tokyo Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan
- Department of Ophthalmology, Tokyo Metropolitan Police Hospital, Nakano, Nakano-ku, Tokyo, Japan
| | - Takashi Fujishiro
- Department of Ophthalmology, University of Tokyo Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan
| | - Kimiko Asano-Shimizu
- Department of Ophthalmology, University of Tokyo Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan
| | - Koichiro Sugimoto
- Department of Ophthalmology, University of Tokyo Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan
| | - Rei Sakata
- Department of Ophthalmology, University of Tokyo Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan
| | - Hiroshi Murata
- Department of Ophthalmology, University of Tokyo Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan
| | - Ryo Asaoka
- Department of Ophthalmology, University of Tokyo Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan
| | - Megumi Honjo
- Department of Ophthalmology, University of Tokyo Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan
| | - Makoto Aihara
- Department of Ophthalmology, University of Tokyo Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan
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Characteristics of Patients with Pseudoexfoliation Syndrome at a Tertiary Eye Care Center in Jordan: A Retrospective Chart Review. Ophthalmol Ther 2020; 10:51-61. [PMID: 33123988 PMCID: PMC7886922 DOI: 10.1007/s40123-020-00319-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Accepted: 10/23/2020] [Indexed: 10/27/2022] Open
Abstract
PURPOSE To present the clinical profile of patients with pseudoexfoliation (PXF) and describe its association with pseudoexfoliation glaucoma and cataract surgery complications at a university hospital in Jordan. METHODS Electronic chart search was performed among patients aged ≥ 50 years who attended the Jordan University Hospital between January 2015 and March 2018, to identify patients with pseudoexfoliation. Data derived from history and ophthalmic examination regarding laterality of pseudoexfoliation, presence of glaucoma, glaucoma surgery, cataract, cataract surgery, lens instability, and complications of cataract surgery were collected and analyzed. RESULTS Of 19,753 patient records searched, 962 (477 male and 485 female) had PXF (4.9%). The mean (SD) age was 71.8 (8.1) years. Pseudoexfoliation was unilateral in 539 patients (56.0%). The mean age of patients with clinically bilateral PXF was significantly higher than those with clinically unilateral PXF (p = 0.001). Pseudoexfoliation glaucoma was present in 237 of 962 (25.4%) patients with PXF and was significantly associated with clinically bilateral PXF (p < 0.001) and male gender (p = 0.001). In 454 (48.9%) patients (638 eyes) who underwent cataract surgery, there was no statistically significant difference in the rate of intraoperative complications between PXF eyes and the fellow eyes of clinically unilateral PXF eyes (p = 0.37), or between patients with clinically unilateral and clinically bilateral PXF (p = 0.78). CONCLUSION In this large hospital-based study, the frequency of PXF was 4.9%. Glaucoma was present in one fourth of patients and was significantly associated with clinically bilateral PXF and male gender. Cataract surgery complication rates were not statistically different between PXF and the fellow eyes of clinically unilateral PXF eyes. Surgeons need to be aware of the potential increased risk of intraoperative complications in both groups.
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Prevalence and Associated Factors of Pseudoexfoliation in a Russian Population: The Ural Eye and Medical Study. Am J Ophthalmol 2020; 210:158-166. [PMID: 31606443 DOI: 10.1016/j.ajo.2019.10.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 09/21/2019] [Accepted: 10/02/2019] [Indexed: 12/30/2022]
Abstract
PURPOSE To assess the prevalence of pseudoexfoliation (PEX) and its associations in a Russian population. DESIGN Population-based cross-sectional study. METHODS Setting: Ufa capital of Bashkortostan, Russia and a rural region in Bashkortostan. PARTICIPANTS the Ural Eye and Medical Study included 5,899 (80.5%) of 7,328 eligible individuals (mean age, 59.0 ± 10.7 years old; range, 40-94 years). OBSERVATION PROCEDURES as part of an ophthalmological and general examination, presence and degree of PEX was assessed using slit-lamp biomicroscopy after medical pupillary dilation. MAIN OUTCOME MEASUREMENTS PEX prevalence. RESULTS After excluding pseudophakic and aphakic individuals, the study included 5,451 (92.4%) participants. PEX prevalence (3.6%; 95% confidence interval [CI]:3.1-4.1), increased from 0.5% (95% CI, 0.1-0.9) in individuals 40 to <50 years old to 10.4% (95% CI, 5.0-15.8) in individuals aged 80+ years. Higher PEX prevalence was associated (multivariate analysis) with older age (odds ratio [OR], 1.09; 95% CI, 1.07-1.11; P < 0.001), Russian ethnicity (OR, 1.50; 95% CI, 2.09-1.11;P = 0.02), higher prevalence of open-angle glaucoma (OR, 2.40; 95% CI, 1.36-4.23;P = 0.003), and higher intraocular pressure (OR, 1.06; 95% CI, 1.02-1.09;P = 0.001). PEX prevalence was not significantly associated with gender (P = 0.49), region of habitation (P = 0.11), body mass index (P = 0.68), level of education (P = 0.26), smoking (P = 0.11), alcohol consumption (P = 0.52), history of cardiovascular or cerebrovascular disease (P = 0.94) and dementia (P = 0.77), prevalence of diabetes mellitus (P = 0.16), arterial hypertension (P = 0.45), chronic obstructive pulmonary disease (P = 0.73), chronic kidney disease (P = 0.09), and hearing loss (P = 0.31). CONCLUSIONS In this typical, ethnically mixed, population from Russia with an age of 40+ years, PEX prevalence (3.6%; 95% CI, 3.1-4.1) was associated with older age, Russian ethnicity, higher intraocular pressure and open-angle glaucoma. It was independent of any systemic parameter including diabetes, arterial hypertension, previous cardiovascular and cerebrovascular diseases and dementia.
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Kóthy P, Holló G. Real-life experience of using brinzolamide/brimonidine fixed drop combination in a tertiary glaucoma centre. Int Ophthalmol 2019; 40:377-383. [PMID: 31650353 DOI: 10.1007/s10792-019-01194-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 10/10/2019] [Indexed: 11/25/2022]
Abstract
PURPOSE To investigate the intraocular pressure (IOP)-lowering efficacy and tolerance of brinzolamide/brimonidine fixed combination (BBFC) under real-life conditions in a tertiary glaucoma centre. METHODS Medical records of all ocular hypertensive and open-angle glaucoma patients (n = 52) treated with BBFC were retrospectively analysed. RESULTS Thirty-nine patients had primary open-angle, 6 exfoliative, 2 pigment, 1 normal tension and 1 juvenile open-angle glaucoma and 3 ocular hypertension. The prior therapy was a prostaglandin analogue (PG) (n = 4), PG/timolol (n = 20), PG/timolol and topical carbonic anhydrase inhibitor (CAI; n = 19), timolol/CAI (n = 1), PG and CAI (n = 4), timolol/pilocarpine and PG (n = 1), timolol/brimonidine and PG (n = 1) and timolol/brimonidine, PG and CAI (n = 2). These were simplified to PG/timolol and BBFC (n = 41), PG and BBFC (n = 9), timolol and BBFC (n = 1) and timolol/pilocarpine, PG and BBFC (n = 1). The IOP on the study eyes was 21.2 ± 3.7 mmHg before and 16.9 ± 2.6, 16.0 ± 2.2, 17.6 ± 3.1 and 18.0 ± 3.1 mmHg after the introduction of BBFC at month 1, 3, 6 and 12, respectively (p < 0.0003 for all time points compared to baseline, p = 1.0 for all other comparisons). Thirty-one patients (59.6%) experienced no adverse event, 17 (32.7%) reported ocular and 6 (11.5%) systemic adverse events. BBFC therapy was terminated on 27 patients (51.9%): on 19 (36.5%) due to adverse events and on 8 (15.4%) due to insufficient IOP reduction. CONCLUSION In real-life practice, the introduction of BBCF allows significant and clinically meaningful IOP reduction and therapy simplification in glaucoma patients requiring complex medication, but in more than one third of the patients it is not tolerated due to adverse events.
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Affiliation(s)
- Péter Kóthy
- Department of Ophthalmology, Semmelweis University, Mária u. 39, Budapest, 1085, Hungary
| | - Gábor Holló
- Department of Ophthalmology, Semmelweis University, Mária u. 39, Budapest, 1085, Hungary.
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Ferguson TJ, Ibach M, Schweitzer J, Karpuk KL, Stephens JD, Berdahl JP. Trabecular micro‐bypass stent implantation with cataract extraction in pigmentary glaucoma. Clin Exp Ophthalmol 2019; 48:37-43. [DOI: 10.1111/ceo.13638] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 07/29/2019] [Accepted: 09/07/2019] [Indexed: 11/30/2022]
Affiliation(s)
| | - Mitch Ibach
- Vance Thompson Vision Sioux Falls South Dakota
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17
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Neuhann TH, Hornbeak DM, Neuhann RT, Giamporcaro JE. Long-term effectiveness and safety of trabecular microbypass stent implantation with cataract surgery in patients with glaucoma or ocular hypertension: Five-year outcomes. J Cataract Refract Surg 2019; 45:312-320. [DOI: 10.1016/j.jcrs.2018.10.029] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 08/13/2018] [Accepted: 10/01/2018] [Indexed: 11/28/2022]
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Tekin K, Inanc M, Elgin U. Monitoring and management of the patient with pseudoexfoliation syndrome: current perspectives. Clin Ophthalmol 2019; 13:453-464. [PMID: 30880906 PMCID: PMC6402616 DOI: 10.2147/opth.s181444] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Pseudoexfoliation syndrome (PES) is a complex and age-related systemic disorder characterized by the progressive accumulation and granular deposition of pseudoexfoliative material in various intraocular and extraocular tissues. The diagnosis of PES is so important because it is a major risk factor for complications during cataract surgery and the most frequent cause of secondary glaucoma. In addition to ocular complications, PES is related with numerous systemic abnormalities, for which the list is growing steadily. Therefore, management and monitoring of patients with PES are crucial. The aim of this paper was to review current perspectives on monitoring patients with PES and addressing management of ocular and systemic associations of this clinically important and biologically fascinating disease.
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Affiliation(s)
- Kemal Tekin
- Ophthalmology Department, Erciş State Hospital, Erciş, Van, Turkey,
| | - Merve Inanc
- Ophthalmology Department, Erciş State Hospital, Erciş, Van, Turkey,
| | - Ufuk Elgin
- Ophthalmology Department, Ulucanlar Eye Training and Research Hospital, University of Health Sciences, Ankara, Turkey
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Maric VD, Grgurevic AD, Cirkovic AM, Marjanovic IS, Bozic MM. The clinical features in patients with newly diagnosed pseudoexfoliative glaucoma in Serbia. Eur J Ophthalmol 2019; 30:513-524. [PMID: 30808180 DOI: 10.1177/1120672119831532] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
PURPOSE To evaluate the clinical characteristics of newly diagnosed pseudoexfoliative glaucoma and compare them with those pertaining to newly diagnosed primary open-angle glaucoma as well as pseudoexfoliation syndrome. METHODS This case-control study involved 306 participants, including patients with newly diagnosed pseudoexfoliative glaucoma, age- and sex-matched normal controls, patients with newly diagnosed primary open-angle glaucoma, and subjects with pseudoexfoliation syndrome. The study was conducted at the Glaucoma Department of Clinic for Eye Diseases, Clinical Center of Serbia, as the referral center for glaucoma in Serbia. RESULTS The mean age in the pseudoexfoliative glaucoma, primary open-angle glaucoma, pseudoexfoliation syndrome, and normal control groups was 73.61 ± 8.46, 65.50 ± 8.97, 74.81 ± 6.80, and 73.58 ± 9.34 years, respectively (pseudoexfoliative glaucoma vs primary open-angle glaucoma, p < 0.001). Unilateral pseudoexfoliative glaucoma was diagnosed in 35 patients (42.2%). The intraocular pressure was higher in the eyes affected by pseudoexfoliative glaucoma (32.0 ± 9.5 mmHg) than that in the primary open-angle glaucoma eyes (28.8 ± 5.9 mmHg) (p < 0.001). In pseudoexfoliative glaucoma and primary open-angle glaucoma eyes, glaucoma severity was determined via the vertical cup-to-disk ratio (C/D) 0.65 (0.45-1.0) versus 0.60 (0.45-1.0), p = 0.048 and visual field mean deviation -5.68 (-1.58 to -30.9) versus -4.70 (-1.39 to -31.0), p = 0.045. Alzheimer's was the only systemic disease associated with pseudoexfoliative glaucoma in the study sample, with an odds ratio of 0.021 (95% confidence interval = 0.00-21.52, p = 0.022). CONCLUSION At the time of diagnosis, pseudoexfoliative glaucoma exhibits different clinical features compared with primary open-angle glaucoma. Higher intraocular pressure, narrow or occludable angle, increased trabecular pigmentation, phacodonesis, and poorer pupillary dilatation emerged as the factors associated with pseudoexfoliative glaucoma.
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Affiliation(s)
- Vesna D Maric
- Clinic for Eye Diseases, Clinical Center of Serbia, Belgrade, Serbia.,Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Anita D Grgurevic
- Institute of Epidemiology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Andja M Cirkovic
- Department for Medical Statistics and Informatics, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Ivan S Marjanovic
- Clinic for Eye Diseases, Clinical Center of Serbia, Belgrade, Serbia.,Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Marija M Bozic
- Clinic for Eye Diseases, Clinical Center of Serbia, Belgrade, Serbia.,Faculty of Medicine, University of Belgrade, Belgrade, Serbia
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20
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Lledó VE, Alkozi HA, Pintor J. Yellow Filter Effect on Melatonin Secretion in the Eye: Role in IOP Regulation. Curr Eye Res 2019; 44:614-618. [PMID: 30640554 DOI: 10.1080/02713683.2019.1570276] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Purpose: Melatonin is a neurohormone mainly synthesized in the pineal gland; however, it is also present in the aqueous humor. One of melatonins' functions in the eye is the regulation of intraocular pressure (IOP). Melatonin is known to be sensitive to light. Recently, the photopigment which controls melatonin synthesis, melanopsin, was found in the crystalline lens. Therefore, light conditions are an interesting possible way of regulating melatonin levels in the aqueous humor. The current study used yellow filters, since melanopsin is activated by short wavelength (blue light). Methods: New Zealand white rabbits were used, divided in two groups, one under controlled 12 h light/dark cycles, while the rest had their cages encased with a yellow filter (λ 465-480). IOP measurements were taken every week at the same time before they were anesthetized for aqueous humor extraction. Results: Keeping the rabbits under the yellow filter resulted in a decrease in IOP up to 43.8 ± 7.8% after 3 weeks. This effect was reversed after the topical application of selective and nonselective melatonin receptors antagonists, 4PPDOT and luzindole. Also, blocking melanopsin by its antagonist AA92593 under white light condition decreased IOP. Finally, melatonin levels were found significantly higher in the aqueous humor of rabbits developed under yellow filter compared to controls (37.4 ± 4.2 and 15.3 ± 3.1 ng/ml, respectively). Conclusion: Yellow filters modulate melatonin levels in the aqueous humor due to deactivating melanopsin activity. This effect leads to a decrease in IOP mediated by melatonin receptors.
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Affiliation(s)
- Victoria Eugenia Lledó
- a Department of Biochemistry and Molecular Biology, Faculty of Optics and Optometry , University Complutense of Madrid , Madrid , Spain
| | - Hanan Awad Alkozi
- a Department of Biochemistry and Molecular Biology, Faculty of Optics and Optometry , University Complutense of Madrid , Madrid , Spain
| | - Jesús Pintor
- a Department of Biochemistry and Molecular Biology, Faculty of Optics and Optometry , University Complutense of Madrid , Madrid , Spain
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Holló G, Katsanos A, Boboridis KG, Irkec M, Konstas AGP. Preservative-Free Prostaglandin Analogs and Prostaglandin/Timolol Fixed Combinations in the Treatment of Glaucoma: Efficacy, Safety and Potential Advantages. Drugs 2018; 78:39-64. [PMID: 29196953 DOI: 10.1007/s40265-017-0843-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Glaucoma therapy-related ocular surface disease (OSD) is a serious pathology with a broad spectrum of insidious clinical presentations and complex pathogenesis that undermines long-term glaucoma care. Preservatives, especially benzalkonium chloride (BAK), contained in topical intraocular pressure-lowering medications frequently cause or aggravate OSD in glaucoma. Management of these patients is challenging, and to date often empirical due to the scarcity of controlled long-term clinical trials. Most of the available data are extracted from case series and retrospective analysis. Preservative-free prostaglandins and prostaglandin/timolol fixed combinations are novel options developed to remove the harmful impact of preservatives, especially BAK, upon ocular tissues. Based on what is currently known on the value of preservative-free antiglaucoma therapies it is tempting to speculate how these new therapies may affect the future medical management of all glaucoma patients. This article provides a comprehensive and critical review of the current literature on preservative-free prostaglandins and preservative-free prostaglandin/timolol fixed combinations.
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Affiliation(s)
- Gábor Holló
- Department of Ophthalmology, Semmelweis University, Maria u. 39, Budapest, 1085, Hungary.
| | - Andreas Katsanos
- Ophthalmology Department, University of Ioannina, Ioannina, Greece
| | - Kostas G Boboridis
- Third Ophthalmology Department, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Murat Irkec
- Department of Ophthalmology, Faculty of Ophthalmology, Hacettepe University, Ankara, Turkey
| | - Anastasios G P Konstas
- 1st University Department of Ophthalmology, Aristotle University of Thessaloniki, Thessaloniki, Greece.,3rd University Department of Ophthalmology, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Hengerer FH, Auffarth GU, Riffel C, Conrad-Hengerer I. Prospective, Non-randomized, 36-Month Study of Second-Generation Trabecular Micro-Bypass Stents with Phacoemulsification in Eyes with Various Types of Glaucoma. Ophthalmol Ther 2018; 7:405-415. [PMID: 30430427 PMCID: PMC6258575 DOI: 10.1007/s40123-018-0152-8] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Indexed: 11/24/2022] Open
Abstract
Introduction The aim of this study was to assess 36-month outcomes after cataract surgery and implantation of two second-generation trabecular micro-bypass stents (iStent inject, Glaukos Corporation, San Clemente, CA, USA) into eyes with predominantly primary open-angle glaucoma (POAG) or pseudoexfoliative glaucoma (PEX). Methods This prospective, non-randomized, consecutive cohort study included eyes with POAG (n = 60), PEX (n = 15), appositional narrow-angle (n = 4), pigmentary (n = 1), or neovascular (secondary) (n = 1) glaucoma and cataract requiring surgery. All eyes (n = 81) underwent ab interno iStent inject implantation following cataract surgery. Effectiveness endpoints through 36 months included intraocular pressure (IOP), number of medications, and proportion of eyes with ≥ 20% IOP reduction, IOP ≤ 18 mmHg, and IOP ≤ 15 mmHg. Safety measures included corrected distance visual acuity (CDVA), adverse events, and secondary surgeries. Outcomes were evaluated for the overall cohort, and for the POAG and PEX subgroups. Results Preoperatively, 32.1% of eyes had undergone prior glaucoma surgery, 56% were on 3–4 medications, and 1 eye (1%) was medication-free. At 36 months postoperatively, mean IOP reduced by 37% (14.3 ± 1.7 mmHg versus 22.6 ± 6.2 mmHg preoperatively), and mean medication burden decreased by 68% (0.8 ± 0.9 versus 2.5 ± 1.1 medications preoperatively). IOP reduced by ≥ 20% in 78% of eyes; 100% of eyes reached IOP ≤ 18 mmHg and 71% reached ≤ 15 mmHg. Medication burden reduced considerably: 22 eyes (54%) were medication-free compared to 1 eye (1%) preoperatively; 1 eye (2%) required ≥ 3 medications compared to 45 eyes (56%) preoperatively; and 92.7% of eyes required reduced medications postoperatively. From 3 through 36 months, mean IOP remained ≤ 15.0 mmHg, and mean number of medications remained ≤ 0.9. Outcomes in the POAG and PEX subgroups included 33% and 32% lower IOP, and 68% and 64% fewer medications, respectively. iStent inject showed a favorable safety profile, including no intraoperative complications, minimal adverse events, and a stable CDVA. Conclusion This real-world cohort of eyes with various types of glaucoma and considerable disease burden exhibited durable and safe IOP and medication reductions through 36 months following iStent inject implantation with cataract surgery. Outcomes were similarly beneficial in eyes with POAG and PEX. Funding Article processing charges were funded by Glaukos Corporation (San Clemente, CA, USA).
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Affiliation(s)
- Fritz H Hengerer
- University Eye Hospital, University of Heidelberg, Heidelberg, Germany.
| | - Gerd U Auffarth
- University Eye Hospital, University of Heidelberg, Heidelberg, Germany
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24
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Bengtsson B, Heijl A, Johannesson G, Andersson-Geimer S, Aspberg J, Lindén C. The Glaucoma Intensive Treatment Study (GITS), a randomized clinical trial: design, methodology and baseline data. Acta Ophthalmol 2018; 96:557-566. [PMID: 30171664 DOI: 10.1111/aos.13791] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 03/21/2018] [Indexed: 01/19/2023]
Abstract
PURPOSE The primary objective of the ongoing Glaucoma Intensive Treatment Study (GITS) is to evaluate the effectiveness of immediate intensive treatment in comparison with the commonly recommended stepped regimen on the predicted visual field. The two treatment arms are also being compared regarding quality of life (QoL), intraocular pressure (IOP) reduction, frequency of reported side-effects, adverse events and adherence to prescribed treatment. DESIGN A randomized, two-centre, prospective open-labelled treatment trial for open-angle glaucoma. PARTICIPANTS Individuals aged 40-78 years with previously untreated and newly diagnosed glaucoma with early to moderate visual field loss were eligible. METHODS Patients were randomized to initial treatment either using drug monotherapy in accordance with common glaucoma guidelines or using a more intensive approach including eyedrops containing drugs from three different classes combined with 360° laser trabeculoplasty. The patients are to be followed for 5 years at visits including standard automated perimetry, optical coherence tomography (OPT) and tonometry. Change of treatment is allowed and decided upon jointly with the patient as in conventional glaucoma management. MAIN OUTCOME The estimated predicted preserved visual field and QoL at end of expected lifetime. RESULTS A total of 242 patients, 45% females, mean age 68 years, were randomized. The median untreated IOP was 24 mm Hg, and the median visual field index (VFI), indicating the percentage of a full field, was 92%. CONCLUSION Glaucoma Intensive Treatment Study is a clinical trial in which two groups of patients randomized to different initial intensities of IOP-reducing treatment are being compared with regard to rate of visual field progression and prediction of serious glaucomatous visual field loss at estimated at end of life.
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Affiliation(s)
- Boel Bengtsson
- Department of Clinical Sciences in Malmö, Ophthalmology; Lund University; Malmö Sweden
| | - Anders Heijl
- Department of Clinical Sciences in Malmö, Ophthalmology; Lund University; Malmö Sweden
| | - Gauti Johannesson
- Department of Clinical Sciences, Ophthalmology; Umeå University; Umeå Sweden
| | | | - Johan Aspberg
- Department of Clinical Sciences in Malmö, Ophthalmology; Lund University; Malmö Sweden
| | - Christina Lindén
- Department of Clinical Sciences, Ophthalmology; Umeå University; Umeå Sweden
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25
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Schweitzer C. [Pseudoexfoliation syndrome and pseudoexfoliation glaucoma]. J Fr Ophtalmol 2018; 41:78-90. [PMID: 29329947 DOI: 10.1016/j.jfo.2017.09.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Accepted: 09/16/2017] [Indexed: 01/26/2023]
Abstract
Pseudoexfoliation syndrome is an age-related systemic disease that mainly affects the anterior structures of the eye. Despite a worldwide distribution, reported incidence and prevalence of this syndrome vary widely between ethnicities and geographical areas. The exfoliative material is composed mainly of abnormal cross-linked fibrils that accumulate progressively in some organs such as the heart, blood vessels, lungs or meninges, and particularly in the anterior structures of the eye. The exact pathophysiological process still remains unclear but the association of genetic and environmental factors are thought to play a role in the development and progressive extracellular accumulation of exfoliative material. Hence, LOXL1 gene polymorphisms, responsible for metabolism of some components of elastic fibers and extracellular matrix, and increased natural exposure to ambient ultraviolet or caffeine consumption have been associated with pseudoexfoliation syndrome. Ophthalmological manifestations are commonly bilateral with an asymmetric presentation and can lead to severe visual impairment and blindness more frequently than in the general population, mainly related to glaucoma and cataract. Pseudoexfoliation glaucoma is a major complication of pseudoexfoliation syndrome and represents the main cause of identifiable glaucoma worldwide. Visual field progression is more rapid than that observed in primary open angle glaucoma, and filtering surgery is more frequently required. Nuclear cataract is more frequent and occurs earlier than in the general population. Owing to poorer pupil dilation and increased zonular instability, cataract surgery with pseudoexfoliation is associated with a 5- to 10-fold increase in surgical complications compared to cataract surgery without pseudoexfoliation. Some specific treatments targeting production, formation or accumulation of exfoliative material could improve the prognosis of this syndrome.
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Affiliation(s)
- C Schweitzer
- Service d'ophtalmologie, CHU de Bordeaux, 33000 Bordeaux, France; UMR 1219, Inserm, Bordeaux Population Health Research Center, team LEHA, université Bordeaux, 33000 Bordeaux, France.
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Moghimi S, Mazloumi M, Johari MK, Fard MA, Chen R, Weinreb R, Nouri-Mahdavi K. Comparison of macular choroidal thickness in patients with pseudoexfoliation syndrome to normal control subjects with enhanced depth SD-OCT imaging. J Curr Ophthalmol 2017; 29:258-263. [PMID: 29270471 PMCID: PMC5735235 DOI: 10.1016/j.joco.2017.06.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Revised: 05/16/2017] [Accepted: 06/24/2017] [Indexed: 11/30/2022] Open
Abstract
Purpose To test the hypothesis that macular choroidal thickness is lower in patients with pseudoexfoliation syndrome (PXS) as compared to healthy control subjects. Methods In this cross-sectional, observational study, 38 non-glaucomatous PXS subjects and 37 healthy volunteers were enrolled in a tertiary care Glaucoma Clinic. The macular region was scanned with the enhanced depth imaging (EDI) protocol of a spectral domain optical coherence tomography (SD-OCT) device (Spectralis OCT, Heidelberg Engineering, Heidelberg, Germany). Macular choroidal thickness and volumes were compared in nine sectors of the Early Treatment Diabetic Retinopathy Study (ETDRS) layout profile across the central 3.45 mm zone after manual segmentation of the choroidal thickness. Linear mixed modeling was used to adjust for confounding variables. Results Six PXS eyes and 8 control eyes were excluded due to poor image quality leaving 32 PXS and 29 control eyes for final analyses. The average age and axial length of the PXS and control groups were 67.94 ± 7.30 vs 64.86 ± 7.04 and 22.91 ± 0.77 vs 23.24 ± 0.66 mm, respectively, (P = 0.10 and 0.20). There was no significant difference in retinal nerve fiber layer (RNFL) thickness between the two groups (P = 0.24). The choroidal thickness was significantly lower in the central subfield subfoveal area (P = 0.02) and in the inner superior (P = 0.03) and inner nasal quadrants (P = 0.03) in the PXS group compared to the control group, as was the choroidal volume (P = 0.02). No significant difference was found in macular choroidal thickness after adjusting for age, gender, and axial length. While there was a significant negative association between age and central subfield choroidal thickness in the control group (r = -0.48, P = 0.01), this association was not significant in the PXS group (r = -0.08, P = 0.68). Conclusions Our findings demonstrate that the choroid does not seem to be significantly altered in PXS eyes. Choroidal thickness changes need to be explored in PXS eyes with glaucoma.
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Affiliation(s)
- Sasan Moghimi
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
- Stein Eye Institute, University of California, Los Angeles, CA, USA
- Hamilton Glaucoma Center, Department of Ophthalmology, University of California-San Diego, La Jolla, CA, USA
- Corresponding author. Farabi Eye Research Center, Tehran University of Medical Sciences, Qazvin Sq., Tehran, Iran.Farabi Eye Research CenterTehran University of Medical SciencesQazvin Sq.TehranIran
| | - Mehdi Mazloumi
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Karim Johari
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Masoud Aghsaie Fard
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Rebecca Chen
- Koret Vision Center, University of California, San Francisco Medical School, San Francisco, CA, USA
| | - Robert Weinreb
- Hamilton Glaucoma Center, Department of Ophthalmology, University of California-San Diego, La Jolla, CA, USA
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Alkozi HA, Franco R, Pintor JJ. Epigenetics in the Eye: An Overview of the Most Relevant Ocular Diseases. Front Genet 2017; 8:144. [PMID: 29075285 PMCID: PMC5643502 DOI: 10.3389/fgene.2017.00144] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2017] [Accepted: 09/22/2017] [Indexed: 01/09/2023] Open
Abstract
Sight for mammals is one of the most appreciated senses. In humans there are several factors that contribute to the increment in all kind of eye diseases. This mini-review will focus on some diseases whose prevalence is steadily increasing year after year for non-genetic reasons, namely cataracts, dry eye, and glaucoma. Aging, diet, inflammation, drugs, oxidative stress, seasonal and circadian style-of-live changes are impacting on disease prevalence by epigenetics factors, defined as stable heritable traits that are not explained by changes in DNA sequence. The mini-review will concisely show the data showing epigenetics marks in these diseases and on how knowledge on the epigenetic alterations may guide therapeutic approaches to have a healthy eye.
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Affiliation(s)
- Hanan A Alkozi
- Department of Biochemistry and Molecular Biology IV, Faculty of Optics and Optometry, University Complutense of Madrid, Madrid, Spain
| | - Rafael Franco
- Department of Biochemistry and Molecular Biomedicine of the University of Barcelona, Institut de Biomedicina de la Universitat de Barcelona (IBUB), Barcelona, Spain.,Cell and Molecular Neuropharmacology, Centro de Investigación Biomédica en Red Enfermedades Neurodegenerativas (CIBERNED), Instituto de Salud Carlos III, Madrid, Spain
| | - Jesús J Pintor
- Department of Biochemistry and Molecular Biology IV, Faculty of Optics and Optometry, University Complutense of Madrid, Madrid, Spain
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Ferguson TJ, Swan R, Ibach M, Schweitzer J, Sudhagoni R, Berdahl JP. Trabecular microbypass stent implantation with cataract extraction in pseudoexfoliation glaucoma. J Cataract Refract Surg 2017; 43:622-626. [DOI: 10.1016/j.jcrs.2017.02.029] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2016] [Revised: 02/03/2017] [Accepted: 02/05/2017] [Indexed: 10/19/2022]
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Structure-Function Correlation Using Confocal Laser Ophthalmoscope in Primary Open-Angle Glaucoma and Pseudoexfoliative Glaucoma. J Glaucoma 2016; 25:377-82. [PMID: 25719234 DOI: 10.1097/ijg.0000000000000233] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To compare Heidelberg Retina Tomograph (HRT) optic disc parameters and structure-function correlation between primary open-angle glaucoma (POAG) and pseudoexfoliative glaucoma (PEXG). DESIGN Prospective, observation case series. PATIENTS AND METHODS A total of 54 POAG and 33 PEXG cases, consecutively recruited from a University Glaucoma Service, underwent a comprehensive ophthalmic examination, including HRT optic disc imaging. Glaucoma definition required the presence of both structural and functional damage. One eye per subject was included in the analysis. T test, Mann-Whitney U test, and analysis of covariance were used to compare HRT parameters between POAG and PEXG, adjusting for age, mean deviation (MD) in the visual field, intraocular pressure, and disc area. The correlation between HRT and MD was assessed in each group. RESULTS Cup area (P=0.048), height variation contour (P=0.016), and cup/disc area ratio (P=0.023) were higher in POAG, whereas the mean retinal nerve fiber layer thickness (P=0.048), retinal nerve fiber layer cross-section area (P=0.044), and rim area (P=0.048) were lower in POAG, compared with PEXG. The correlation of HRT parameters with MD was significant only in the POAG group. CONCLUSIONS At a similar level of functional damage, POAG subjects presented with more pronounced structural damage than PEXG subjects. The correlation between HRT and visual field parameters was more evident in POAG, compared with PEXG.
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Founti P, Haidich AB, Chatzikyriakidou A, Salonikiou A, Anastasopoulos E, Pappas T, Lambropoulos A, Viswanathan AC, Topouzis F. Ethnicity-Based Differences in the Association of LOXL1 Polymorphisms with Pseudoexfoliation/Pseudoexfoliative Glaucoma: A Meta-Analysis. Ann Hum Genet 2015; 79:431-50. [PMID: 26404116 DOI: 10.1111/ahg.12128] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Accepted: 07/05/2015] [Indexed: 01/09/2023]
Abstract
Pseudoexfoliation (PEX) is an age-related disorder of the extracellular matrix; it is strongly associated with glaucoma, the leading cause of irreversible blindness worldwide. We conducted an ethnic-based meta-analysis of the association of LOXL1 polymorphisms with PEX/pseudoexfoliative glaucoma (PEXG). Association studies were retrieved systematically from PubMed, EMBASE, and Web of Knowledge. Allelic and genotype frequencies of rs3825942, rs1048661, and rs2165241 were compared between PEX/PEXG and controls. Odds ratios (OR) and 95% confidence intervals (CI) were calculated using a random effects model. Overall, 39 independent cohorts were included. Rs3825942 (G) was an at risk allele for PEX/PEXG in Caucasians, Japanese, Koreans, Chinese, South Asians, and Middle Easterners, but protective in Black South Africans (OR = 0.10, 95%CI:0.06-0.16). Rs1048661 (G) was an at risk allele for PEX/PEXG in Caucasians, South Asians, Middle Easterners and Black South Africans, but was protective in Japanese (OR = 0.03, 95%CI:0.02-0.06) and Koreans (OR = 0.10, 95%CI:0.05-0.22). These associations we-re confirmed for the genotypic recessive models. Rs2165241 (C) was a protective allele for PEX/PEXG in Caucasians, but was an at risk allele in Japanese (OR = 7.49, 95%CI:3.22-17.41) and Koreans (OR = 6.63, 95%CI:2.60-16.90). This was confirmed for the genotypic dominant model. Other genetic and/or environmental factors may modify the effect of LOXL1 polymorphisms in certain ethnic groups.
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Affiliation(s)
- Panayiota Founti
- Department of Ophthalmology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece.,Moorfields Eye Hospital, London, UK
| | - Anna-Bettina Haidich
- Department of Hygiene and Epidemiology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Anthoula Chatzikyriakidou
- Department of Biology and Genetics, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Angeliki Salonikiou
- Department of Ophthalmology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Eleftherios Anastasopoulos
- Department of Ophthalmology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Theofanis Pappas
- Department of Ophthalmology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Alexandros Lambropoulos
- Department of Biology and Genetics, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Ananth C Viswanathan
- NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, University College London, Institute of Ophthalmology, London, UK
| | - Fotis Topouzis
- Department of Ophthalmology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Update on pseudoexfoliation syndrome pathogenesis and associations with intraocular pressure, glaucoma and systemic diseases. Curr Opin Ophthalmol 2015; 26:82-9. [PMID: 25594764 DOI: 10.1097/icu.0000000000000132] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE OF REVIEW Pseudoexfoliation (PEX) syndrome is a common age-related disorder affecting intraocular and extraocular tissues. This review focuses on recent publications related with the pathogenesis and associations of PEX syndrome with intraocular pressure (IOP), glaucoma and systemic diseases. RECENT FINDINGS In PEX tissues, expression of lysyl oxidase-like 1 (LOXL1) was found to be markedly dysregulated. This may adversely affect elastin metabolism and lead to elastotic alteration in tissues such as lamina cribrosa. There is increasing evidence that cellular stress conditions and low-grade chronic inflammatory processes are involved in the pathogenesis of PEX. Although there is an increased risk for glaucoma development in patients with PEX and ocular hypertension as compared with non-PEX patients with ocular hypertension, LOXL1 single nucleotide polymorphisms were not associated with intraocular pressure (IOP) differences. Lack of association of PEX with all-cause mortality or dementia has been reported recently. The association with vascular diseases is not consistent among different studies. SUMMARY Despite the high prevalence of the LOXL1 variants in the general population, a much lower proportion of the population develops PEX, suggesting that in addition to LOXL1, other genetic, epigenetic and environmental factors may contribute to the development of PEX. Also, LOXL1 cannot help to identify those with PEX at increased risk for glaucoma development. Increased risk for glaucoma development in PEX patients who present with increased IOP may be related to other factors beyond IOP, contributing to increased vulnerability of the optic nerve to glaucoma development in the presence of PEX.
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Anastasopoulos E, Coleman AL, Wilson MR, Sinsheimer JS, Yu F, Katafigiotis S, Founti P, Salonikiou A, Pappas T, Koskosas A, Katopodi T, Lambropoulos A, Topouzis F. Association of LOXL1 polymorphisms with pseudoexfoliation, glaucoma, intraocular pressure, and systemic diseases in a Greek population. The Thessaloniki eye study. Invest Ophthalmol Vis Sci 2014; 55:4238-43. [PMID: 24917141 DOI: 10.1167/iovs.14-13991] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
PURPOSE To investigate the association of the two single-nucleotide polymorphisms (SNPs) in the lysyl oxidase-like 1 (LOXL1) gene with pseudoexfoliation syndrome (PEX), pseudoexfoliative glaucoma (PEXG), and primary open-angle glaucoma (POAG) in a Greek population-based setting, from the Thessaloniki Eye study. METHODS A total of 233 subjects with successful DNA extraction, PCR amplification, and genotyping were included in the genetic analysis of G153D and R141L SNPs of LOXL1 gene and classified into four groups: controls (n = 93); subjects with PEX (n = 40); POAG (n = 66); and PEXG (n = 34). Multinomial logistic regression was used to test their association with LOXL1 SNPs with adjustment for covariates. The association of LOXL1 with IOP (in untreated subjects) and with systemic diseases was explored. RESULTS Both LOXL1 SNPs were present in high frequencies in controls and cases. The G153D was strongly associated with both PEX (odds ratio [OR] = 23.2, P = 0.003 for allele G) and PEXG (OR = 24.75, P = 0.003 for allele G) and was not associated with POAG (P = 0.451). In contrast, the R141L was not associated with PEX (P = 0.81), PEXG (P = 0.063), or POAG (P = 0.113). No association of the G153D with either intraocular pressure (IOP) or systemic diseases was found. CONCLUSIONS In the Thessaloniki Eye Study, the G153D SNP of LOXL1 gene was strongly associated with both PEX and PEXG, whereas the R141L was not associated. No association of the LOXL1 with IOP or with systemic diseases was found. These findings further support the hypothesis that the LOXL1 gene contributes to onset of PEXG through PEX. Gene variants of LOXL1 do not help to identify those with PEX at increased risk for glaucoma development.
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Affiliation(s)
- Eleftherios Anastasopoulos
- Department of Ophthalmology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Anne L Coleman
- Center for Eye Epidemiology, Jules Stein Eye Institute, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States
| | - M Roy Wilson
- School of Medicine, Wayne State University, Detroit, Michigan, United States
| | - Janet S Sinsheimer
- Department of Human Genetics, Department of Biomathematics, David Geffen School of Medicine at UCLA and Department of Biostatistics, UCLA School of Public Health, California, United States
| | - Fei Yu
- Center for Eye Epidemiology, Jules Stein Eye Institute, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States
| | - Sokratis Katafigiotis
- Laboratory of General Biology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Panayiota Founti
- Department of Ophthalmology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Angeliki Salonikiou
- Department of Ophthalmology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Theofanis Pappas
- Department of Ophthalmology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Archimidis Koskosas
- Department of Ophthalmology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Theodora Katopodi
- Laboratory of General Biology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Alexandros Lambropoulos
- Laboratory of General Biology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Fotis Topouzis
- Department of Ophthalmology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Schlötzer-Schrehardt U, Naumann GOH. [Pseudoexfoliation syndrome/glaucoma. Causes, consequences and management]. Ophthalmologe 2013; 109:942-3. [PMID: 23053329 DOI: 10.1007/s00347-012-2530-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- U Schlötzer-Schrehardt
- Universitäts-Augenklinik, Friedrich-Alexander-Universität Erlangen-Nürnberg, Schwabachanlage 6, 91054 Erlangen.
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[New pathogenetic insights into pseudoexfoliation syndrome/glaucoma. Therapeutically relevant?]. Ophthalmologe 2013; 109:944-51. [PMID: 23053330 DOI: 10.1007/s00347-012-2531-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Pseudoexfoliation (PEX) syndrome is a genetically determined, generalized disease of the extracellular matrix leading to the progressive deposition of an abnormal fibrillar material in various intraocular and extraocular tissues including the trabecular meshwork. It thus represents the most common identifiable cause of open-angle glaucoma and a leading cause of blindness worldwide. The PEX-specific fibrotic matrix process, a stress-induced elastosis, is characterized by an excessive production and abnormal cross-linking of elastic microfibrils into fibrillar PEX aggregates. Co-modulating factors triggering this fibrotic process include elevated concentrations of fibrogenic growth factors, such as TGF-β1, reduced activity of proteolytic enzymes, subtle inflammatory processes and various external stress factors, such as oxidative stress. Genetic studies identified a highly significant association between several polymorphisms in the LOXL1 (lysyl oxidase-like 1) gene with both PEX syndrome and PEX glaucoma. As these LOXL1 risk variants were found to occur in almost 100% of PEX patients throughout all geographical populations worldwide, LOXL1 appears to represent a principal risk factor for manifestation of the PEX phenotype. LOXL1 is a pivotal cross-linking enzyme in extracellular matrix metabolism and seems to be specifically required for elastic fiber formation and stabilization. The available data suggest that LOXL1 enzyme function and expression are dysregulated in PEX tissues and thereby play a central role in glaucoma development. On the one hand, increased expression of LOXL1 and elastic fiber components contributes to the formation of abnormally cross-linked PEX aggregates in the outflow pathways leading to increased outflow resistance and intraocular pressure. On the other hand, reduced expression and inadequate tissue levels of LOXL1 may lead to degenerative tissue alterations, particularly in the lamina cribrosa adversely affecting the biomechanical properties of this critical tissue. This PEX-specific elastinopathy of the lamina cribrosa rendering PEX eyes more vulnerable to pressure-induced optic nerve damage may constitute an independent risk factor for glaucoma development. The findings may have direct consequences for the clinical management of PEX patients underlining the need for an exact diagnosis, a strict IOP-reducing therapy and a close and regular follow-up.
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Jonas JB, Nangia V, Matin A, Bhojwani K, Sinha A, Khare A, Agarwal S, Bhate K. Pseudoexfoliation: normative data and associations. The Central India Eye and Medical Study. PLoS One 2013; 8:e76770. [PMID: 24204672 PMCID: PMC3804587 DOI: 10.1371/journal.pone.0076770] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2013] [Accepted: 08/29/2013] [Indexed: 12/26/2022] Open
Abstract
Purpose To assess the prevalence of pseudoexfoliation (PEX) and its associations in a population-based setting. Design Population-based, cross-sectional study. Methods The Central India Eye and Medical Study included 4711 individuals. All study participants underwent a detailed ophthalmological examination. After medical pupil dilation, PEX was assessed by an experienced ophthalmologist using slit-lamp based biomicroscopy. Results Slit lamp examination results were available for 4646 (98.6%) study participants with a mean age of 49.3±13.3 years (range: 30–100 years). PEX was detected in 87 eyes (prevalence: 0.95±0.10% (95%CI: 0.75, 1.15) of 69 subjects (prevalence: 1.49±0.18% (95%CI: 1.14, 1.83). PEX prevalence increased significantly (P<0.001) from 0% in the age group of 30–39 years, to 2.85±0.56% in the age group of 60–69 years, to 6.60±1.21% in the age group of 70–79 years, and to 12.3±4.11% in the age group of 80+ years. In multivariate analysis, PEX prevalence was associated with higher age (P<0.001; regression coefficient B:0.11; odds ratio (OR): 1.11 (95%CI: 1.09, 1.13)), lower body mass index (P = 0.001; B: −0.12; OR: 0.88 (95CI: 0.82, 0.95)) and higher diastolic blood pressure (P = 0.002; B: 0.02; OR: 1.03 (95%CI: 1.01, 1.04)). In the multivariate analysis, PEX was not associated with retinal nerve fiber layer cross section area (P = 0.76) and presence of open-angle glaucoma (P = 0.15). Conclusions In a rural Central Indian population aged 30+ years, PEX prevalence (mean: 1.49±0.18%) was significantly associated with older age, lower body mass index and higher diastolic blood pressure. It was not significantly associated with optic nerve head measurements, refractive error, any ocular biometric parameter, nuclear cataract, early age-related macular degeneration and retinal vein occlusion, diabetes mellitus, smoking, and dyslipidemia.
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Affiliation(s)
- Jost B. Jonas
- Suraj Eye Institute, Nagpur, India
- Department of Ophthalmology, Medical Faculty Mannheim of the Ruprecht-Karls-University Heidelberg, Mannheim, Germany
- * E-mail: (VN); (JBJ)
| | - Vinay Nangia
- Suraj Eye Institute, Nagpur, India
- * E-mail: (VN); (JBJ)
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You QS, Xu L, Wang YX, Yang H, Ma K, Li JJ, Zhang L, Jonas JB. Pseudoexfoliation: normative data and associations: the Beijing eye study 2011. Ophthalmology 2013; 120:1551-8. [PMID: 23622877 DOI: 10.1016/j.ophtha.2013.01.020] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2012] [Revised: 01/06/2013] [Accepted: 01/11/2013] [Indexed: 10/26/2022] Open
Abstract
OBJECTIVE To assess the prevalence of pseudoexfoliation syndrome (PEX) and its associations in a population-based setting. DESIGN Population-based, cross-sectional cohort study. PARTICIPANTS Of 4403 eligible subjects with an age of ≥ 50 years, 3468 individuals (78.8%) participated in the Beijing Eye Study 2011 (mean age, 64.6 ± 9.8 years; range, 50-93 years). METHODS All study participants underwent a detailed ophthalmologic examination. After medical pupil dilation, PEX was assessed by an experienced ophthalmologist using slit-lamp-based biomicroscopy. MAIN OUTCOME MEASURES Prevalence and associations of PEX. RESULTS Slit-lamp examination results were available for 3022 study participants (87.1%). Definite pseudoexfoliation was observed in 72 of the 3022 subjects, with a prevalence of 2.38% (95% confidence interval [CI], 1.84-2.93). Suspected PEX was detected in 104 of the subjects (3.44%; 95% CI, 2.8-4.1). The overall prevalence of PEX (definite and suspected) was 176 of 3022 or 5.82% (95% CI, 4.99-6.66). In 80 subjects (45.5%), PEX was detected in both eyes, whereas it was detected only in the right eye in 42 subjects (23.9%) and only in the left eye in 54 (30.7%). The prevalence of PEX increased from 1.1% in among those 50 to 54 years old, to 3.5%, 5.7%, and 11.8% among those 60 to 64 years, 70 to 74 years, and ≥ 80 years, respectively. In multivariate analysis, presence of PEX was significantly associated with older age (P<0.001; odds ratio [OR], 1.08; 95% CI, 1.04-1.10), shorter axial length (P = 0.03; OR, 0.82; 95% CI, 0.68,0.98), and shallower anterior chamber (P = 0.03; OR, 0.59; 95% CI, 0.36-0.95). We found that PEX was not associated (all P>0.05) with sex, diabetes mellitus, blood pressure, psychological depression, smoking, dyslipidemia, body mass index, central corneal thickness, corneal diameter, optic nerve head measurements, choroidal thickness, retinal vessel diameters, early age-related macular degeneration, or retinal vein occlusion. CONCLUSIONS In a North Chinese population aged ≥ 50 years, the prevalence of definite PEX was 2.38% (95% CI, 1.84-2.93), suspect PEX was 3.4% (95% CI, 2.8-4.1) and overall PEX was 5.82% (95% CI, 4.99-6.66). We found PEX to be associated with older age, shorter axial length, and shallower anterior chamber. The relationship between PEX and glaucomatous optic neuropathy remained inconclusive among our population. FINANCIAL DISCLOSURE(S) The authors have no proprietary or commercial interest in any materials discussed in this article.
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Affiliation(s)
- Qi Sheng You
- Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital University of Medical Science, Beijing, China
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Schlötzer-Schrehardt U, Hammer CM, Krysta AW, Hofmann-Rummelt C, Pasutto F, Sasaki T, Kruse FE, Zenkel M. LOXL1 deficiency in the lamina cribrosa as candidate susceptibility factor for a pseudoexfoliation-specific risk of glaucoma. Ophthalmology 2012; 119:1832-43. [PMID: 22633114 DOI: 10.1016/j.ophtha.2012.03.015] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2011] [Revised: 03/07/2012] [Accepted: 03/07/2012] [Indexed: 01/25/2023] Open
Abstract
PURPOSE To test the hypothesis that a primary disturbance in lysyl oxidase-like 1 (LOXL1) and elastin metabolism in the lamina cribrosa of eyes with pseudoexfoliation syndrome constitutes an independent risk factor for glaucoma development and progression. DESIGN Observational, consecutive case series. PARTICIPANTS Posterior segment tissues obtained from 37 donors with early and late stages of pseudoexfoliation syndrome without glaucoma, 37 normal age-matched control subjects, 5 eyes with pseudoexfoliation-associated open-angle glaucoma, and 5 eyes with primary open-angle glaucoma (POAG). METHODS Protein and mRNA expression of major elastic fiber components (elastin, fibrillin-1, fibulin-4), collagens (types I, III, and IV), and lysyl oxidase crosslinking enzymes (LOX, LOXL1, LOXL2) were assessed in situ by quantitative real-time polymerase chain reaction, (immuno)histochemistry, and light and electron microscopy. Lysyl oxidase-dependent elastin fiber assembly was assessed by primary optic nerve head astrocytes in vitro. MAIN OUTCOME MEASURES Expression levels of elastic proteins, collagens, and lysyl oxidases in the lamina cribrosa. RESULTS Lysyl oxidase-like 1 proved to be the major lysyl oxidase isoform in the normal lamina cribrosa in association with a complex elastic fiber network. Compared with normal and POAG specimens, lamina cribrosa tissues obtained from early and late stages of pseudoexfoliation syndrome without and with glaucoma consistently revealed a significant coordinated downregulation of LOXL1 and elastic fiber constituents on mRNA and protein level. In contrast, expression levels of collagens and other lysyl oxidase isoforms were not affected. Dysregulated expression of LOXL1 and elastic proteins was associated with pronounced (ultra)structural alterations of the elastic fiber network in the laminar beams of pseudoexfoliation syndrome eyes. Inhibition of LOXL1 interfered with elastic fiber assembly by optic nerve head astrocytes in vitro. CONCLUSIONS The findings provide evidence for a pseudoexfoliation-specific elastinopathy of the lamina cribrosa resulting from a primary disturbance in LOXL1 regulation and elastic fiber homeostasis, possibly rendering pseudoexfoliation syndrome eyes more vulnerable to pressure-induced optic nerve damage and glaucoma development and progression.
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Kaimbo Wa Kaimbo D. Pseudoexfoliation syndrome in Congolese patients. J Fr Ophtalmol 2011; 35:40-5. [PMID: 22015072 DOI: 10.1016/j.jfo.2011.04.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2011] [Accepted: 04/28/2011] [Indexed: 10/16/2022]
Abstract
PURPOSE To determine the frequency of pseudoexfoliation syndrome (PEX) in Congolese patients and its association with cataract and glaucoma. METHODS We performed a cross-sectional and descriptive analysis of the data from patients diagnosed with PEX. Data were collected between February 2005 and June 2008 in a general practice of ophthalmology in Kinshasa. Patients aged 50 or above who attended the general practice of ophthalmology were included in the study. Each patient underwent complete ophthalmic evaluation, including visual acuity testing, slit-lamp biomicroscopy, applanation tonometry, gonioscopy, and ophthalmoscopy. The diagnosis of PEX was based on presence of typical pseudoexfoliation material on the anterior lens surface and/or the pupillary margin in either or both eyes. RESULTS Of 2142 patients seen during the study period, 37 (59 eyes) had PEX in either eye, for a frequency of 1.73%. The mean (±SD) age of the patients with PEX was 70.40 years±8 (range: 57-87 years). The frequency of PEX had a tendency to increase with age: 0.50% of patients aged 50-59 years had PEX, whereas 7.29% of those aged more or equal to 80 years were affected (P<0.0001), with a female predominance (2.18% of women versus 1.22% of men, P=0.035). PEX was bilateral in 22 (59.46%) of 37 patients (74.58% of eyes). Bilateral PEX was found more often in females (16 patients over 22, 72.72%) than in males (six patients over 15, 40%) (P=0.05). PEX was significantly associated with cataract (P=0.002) and glaucoma (P<0.001). CONCLUSION Despite the limitations inherent in a clinic-based study, this investigation provides an indication of the frequency of PEX in Central Africa. This shows that Congolese patients have a low frequency of PEX (1.73%), inferior to that of black people in South Africa (12.1-16%). This study confirms that PEX is an age-related condition and is associated with cataract and glaucoma, as in other races.
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Affiliation(s)
- D Kaimbo Wa Kaimbo
- Département d'Ophtalmologie, Université de Kinshasa, BP 16540, Kinshasa 1, RD Congo. dieudonne
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Topouzis F, Wilson MR, Harris A, Founti P, Yu F, Anastasopoulos E, Pappas T, Koskosas A, Salonikiou A, Coleman AL. Risk factors for primary open-angle glaucoma and pseudoexfoliative glaucoma in the Thessaloniki eye study. Am J Ophthalmol 2011; 152:219-228.e1. [PMID: 21664597 DOI: 10.1016/j.ajo.2011.01.032] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2010] [Revised: 01/11/2011] [Accepted: 01/11/2011] [Indexed: 10/18/2022]
Abstract
PURPOSE To investigate risk factors for primary open-angle glaucoma (POAG) and pseudoexfoliative glaucoma (PEXG) in the Thessaloniki Eye Study. DESIGN Cross-sectional, population-based study. METHODS Randomly selected subjects 60 years of age and older (n=2554) participated in the Thessaloniki Eye Study. Glaucomatous damage and presence of pseudoexfoliation (PEX) were defined according to specific criteria. Open-angle glaucoma (OAG) subjects were compared with nonglaucoma subjects (controls), POAG subjects were compared with controls without PEX, and PEXG subjects were compared with controls with PEX for demographic, lifestyle, ophthalmic, and systemic factors. Factors with P < .2 in the univariate analysis were retained for multivariate analyses. RESULTS In multivariate analysis restricted to persons who participated in clinic visits and who had at least 1 phakic eye (n=2078), intraocular pressure (odds ratio [OR], 1.21 per 1 mm Hg; P<.001), PEX (OR, 2.81; P<.001), history of coronary artery bypass or vascular surgery (OR, 1.95; P=.017), and moderate-to-high myopia (≥ -3 diopters; OR, 2.40; P=.009) were associated with higher odds for OAG. In analysis including all clinic visits (n=2261), age became significantly associated (OR, 1.05; P=.004). In multivariate analysis for POAG (n=1840), associations were found for age (OR, 1.04 per year; P=.048), IOP (OR, 1.19 per 1 mm Hg; P<.001), history of coronary artery bypass or vascular surgery (OR, 2.09; P=.01), and history of diabetes treated with insulin (OR, 3.05; P=.045). In multivariate analysis for PEXG (n=238), the latter was associated with increased IOP (OR, 1.25 per 1 mm Hg; P<.001). CONCLUSIONS IOP was the only factor associated with both POAG and PEXG, whereas moderate-to-high myopia showed borderline significance in both. Vascular systemic diseases and their treatment were associated only with POAG. The implications of these differences for the pathogenesis between the 2 common types of OAG should be explored further.
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Shazly TA, Farrag AN, Kamel A, Al-Hussaini AK. Prevalence of pseudoexfoliation syndrome and pseudoexfoliation glaucoma in Upper Egypt. BMC Ophthalmol 2011; 11:18. [PMID: 21707986 PMCID: PMC3141806 DOI: 10.1186/1471-2415-11-18] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2011] [Accepted: 06/27/2011] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Pseudoexfoliation (PXF) is a recognized risk factor for developing cataract, glaucoma and lens dislocation. PXF is also associated with increased risk of complications during cataract surgery due to poor mydriasis and zonular weakness. The aim of this study is to report the prevalence of pseudoexfoliation among Upper Egyptians attending the ophthalmology clinic of Assiut University Hospital. METHODOLOGY A retrospective, chart review study conducted in the period from February 2002 to August 2009. A total of 7738 patients aged 40 years or older attending the general ophthalmic clinics were included in this study. A detailed evaluation including ophthalmic and general history, slit lamp biomicroscopy, intraocular pressure measurement, gonioscopy and dilated eye examination were performed. Patients with pseudoexfoliative material on the anterior lens surface and ⁄ or the pupillary margin in either or both eyes were labeled as having PXF. RESULTS Out of the 7738 patients included, three hundred twenty (4.14%) subjects had PXF. Mean age of PXF group was 68.15 years (SD 8.16, range 40-92 years). PXF was bilateral in 82.2% of cases. It was significantly associated with cataract, glaucoma and hearing loss. Of the PXF patients, 65% had cataract, 30.3% had glaucoma and 8.1% had hearing loss. CONCLUSION Pseudoexfoliation appears to be a common disorder in older individuals in Upper Egypt.
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Affiliation(s)
- Tarek A Shazly
- Department of Ophthalmology, Assiut University Hospital, Assiut, Egypt.
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Dordević-Jocić J, Zlatanović G, Veselinović D, Stanković-Babić G, Vujanović M, Zivković M. [Ocular pseudoexfoliation syndrome]. MEDICINSKI PREGLED 2010; 63:681-688. [PMID: 21446099 DOI: 10.2298/mpns1010681d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
INTRODUCTION This study was aimed at providing an update on most recent developments regarding ocular and systemic manifestations and complications, clinical diagnosis and management, and molecular patophysiology of pseudoexfoliation syndrome. METHOD Review of recent literature and own clinical and laboratory studies. RESULTS Pseudoexfoliation syndrome is an age-related disease in which abnormal fibrillar extracellular material is produced and accumulated in many ocular tissues. Recent progress and advances have led to improvements in clinical management by understanding the effects of the pseudoexfoliation process on the ocular tissues, by refining diagnostic criteria and applying new treatment regimes, and by developing preventive strategies to reduce surgical complications. Increasing evidence of systemic associations of cardiovascular, cerebrovascular, abdominal aorta aneurysm can provide better understanding and management of this condition, and new therapeutic goal. The current pathogenesis concept describes psuedoexfoliation syndrome as an elastic microfibrillopathy involving transforming growth factor-beta, matrix metalloproteinase oxidative stress. CONCLUSION Despite extensive research, the exact chemical composition of exfoliation material remains unknown. The presence of pseudoexfoliation should alert the physician to the increased risks of intraocular surgery, most commonly zonular dehiscence, capsular rupture, and vitreous loss during cataract extraction. Its associated clinical signs are important in the detection and management of glaucoma.
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Viso E, Rodríguez-Ares MT, Gude F. Prevalence of pseudoexfoliation syndrome among adult Spanish in the Salnés eye Study. Ophthalmic Epidemiol 2010; 17:118-24. [PMID: 20302433 DOI: 10.3109/09286581003624970] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE To estimate the prevalence of Pseudoexfoliation syndrome (PXF) and to investigate its relationship with systemic and ocular diseases and lifestyle factors in a general adult population in north-western Spain. METHODS An age-stratified random sample of 1155 subjects was drawn from the population aged 40 years and over of O Salnés (Spain). From 937 eligible subjects, 619 (66.1%) participated (mean age (Standard Deviation [SD]): 63.4 (14.5) years, range: 40-96, 37.0% males). An interview to collect past history of ocular and systemic diseases and lifestyle details, and a comprehensive ophthalmic evaluation were performed. Study subjects with typical pseudoexfoliative material on the anterior capsule or in the pupil margin were labelled as having PXF. A design based analysis was performed and all calculations were weighted to give unbiased estimates. RESULTS The prevalence of PXF was 6.5% (95% confidence interval [CI]:4.9-8.1). PXF rates increased significantly with age (P = 0.000). No cases of PXF were detected in subjects between 40 and 60 years. Prevalence of PXF was 8.0% (95% C I5.4-11.6) in men and 5.4% (95% CI 3.8-7.6) in women (P = ns). The prevalence of glaucoma in subjects with PXF was 19.6% (95% CI 8.2-40.0). After controlling for age and sex, glaucoma, cataract surgery, rose bengal staining and diabetes were associated with PXF but only glaucoma and rose bengal staining associations remained significant in a multivariate model. CONCLUSIONS PXF is common among older individuals in north-western Spain. Subjects with pseudoexfoliation have a significantly higher prevalence of glaucoma than subjects without. An abnormal ocular surface detected by rose bengal staining is highly prevalent among subjects with pseudoexfoliation.
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Affiliation(s)
- Eloy Viso
- Department of Ophthalmology, Complexo Hospitalario de Pontevedra, Spain.
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Topouzis F, Harris A, Wilson MR, Koskosas A, Founti P, Anastasopoulos E, Pappas T, Yu F, Coleman AL. Reply. Am J Ophthalmol 2010. [DOI: 10.1016/j.ajo.2009.10.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Teus MA. Increased likelihood of glaucoma at the same intraocular pressure in subjects with pseudoexfoliation. Am J Ophthalmol 2010; 149:527; author reply 527-8. [PMID: 20172081 DOI: 10.1016/j.ajo.2009.10.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2009] [Accepted: 10/15/2009] [Indexed: 10/19/2022]
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Parrish RK. Thessaloniki eye study: the importance of recognizing pseudoexfoliation. Am J Ophthalmol 2009; 148:482-3. [PMID: 19782795 DOI: 10.1016/j.ajo.2009.07.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2009] [Accepted: 07/05/2009] [Indexed: 11/15/2022]
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