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Paschalis EI, Zhou C, Sharma J, Dohlman TH, Kim S, Lei F, Chodosh J, Vavvas D, Urtti A, Papaliodis G, Dohlman CH. The prophylactic value of TNF-α inhibitors against retinal cell apoptosis and optic nerve axon loss after corneal surgery or trauma. Acta Ophthalmol 2024; 102:e381-e394. [PMID: 37803488 PMCID: PMC10997738 DOI: 10.1111/aos.15786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 09/13/2023] [Accepted: 09/18/2023] [Indexed: 10/08/2023]
Abstract
BACKGROUND AND PURPOSE Late secondary glaucoma is an often-severe complication after acute events like anterior segment surgery, trauma and infection. TNF-α is a major mediator that is rapidly upregulated, diffusing also to the retina and causes apoptosis of the ganglion cells and degeneration of their optic nerve axons (mediating steps to glaucomatous damage). Anti-TNF-α antibodies are in animals very effective in protecting the retinal cells and the optic nerve-and might therefore be useful prophylactically against secondary glaucoma in future such patients. Here we evaluate (1) toxicity and (2) efficacy of two TNF-α inhibitors (adalimumab and infliximab), in rabbits by subconjunctival administration. METHODS For drug toxicity, animals with normal, unburned corneas were injected with adalimumab (0.4, 4, or 40 mg), or infliximab (1, 10, or 100 mg). For drug efficacy, other animals were subjected to alkali burn before such injection, or steroids (for control). The rabbits were evaluated clinically with slit lamp and photography, electroretinography, optical coherence tomography, and intraocular pressure manometry. A sub-set of eyes were stained ex vivo after 3 days for retinal cell apoptosis (TUNEL). In other experiments the optic nerves were evaluated by paraphenylenediamine staining after 50 or 90 days. Loss of retinal cells and optic nerve degeneration were quantified. RESULTS Subconjunctival administration of 0.4 mg or 4.0 mg adalimumab were well tolerated, whereas 40.0 mg was toxic to the retina. 1, 10, or 100 mg infliximab were also well tolerated. Analysis of the optic nerve axons after 50 days confirmed the safety of 4.0 mg adalimumab and of 100 mg infliximab. For efficacy, 4.0 mg adalimumab subconjunctivally in 0.08 mL provided practically full protection against retinal cell apoptosis 3 days following alkali burn, and infliximab 100 mg only slightly less. At 90 days following burn injury, control optic nerves showed about 50% axon loss as compared to 8% in the adalimumab treatment group. CONCLUSIONS Subconjunctival injection of 4.0 mg adalimumab in rabbits shows no eye toxicity and provides excellent neuroprotection, both short (3 days) and long-term (90 days). Our total. accumulated data from several of our studies, combined with the present paper, suggest that corneal injuries, including surgery, might benefit from routine administration of anti-TNF-α biologics to reduce inflammation and future secondary glaucoma.
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Affiliation(s)
- Eleftherios I. Paschalis
- Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA
- Schepens Eye Research Institute, Boston Keratoprosthesis Laboratory/Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
- Disruptive Technology Laboratory, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA
| | - Chengxin Zhou
- Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA
- Schepens Eye Research Institute, Boston Keratoprosthesis Laboratory/Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
- Disruptive Technology Laboratory, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA
| | - Jyoti Sharma
- Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA
- Schepens Eye Research Institute, Boston Keratoprosthesis Laboratory/Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
- Disruptive Technology Laboratory, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA
| | - Thomas H. Dohlman
- Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA
- Schepens Eye Research Institute, Boston Keratoprosthesis Laboratory/Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - Sarah Kim
- Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA
- Schepens Eye Research Institute, Boston Keratoprosthesis Laboratory/Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - Fengyang Lei
- Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA
- Schepens Eye Research Institute, Boston Keratoprosthesis Laboratory/Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
- Disruptive Technology Laboratory, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA
| | - James Chodosh
- Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA
- Schepens Eye Research Institute, Boston Keratoprosthesis Laboratory/Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
- Disruptive Technology Laboratory, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA
| | - Demetrios Vavvas
- Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA
- Angiogenesis Laboratory, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA
| | - Arto Urtti
- Division of Pharmaceutical Biosciences, University of Helsinki, Finland and School of Pharmacy, University of Eastern Finland, Kuopio, Finland
| | - George Papaliodis
- Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA
| | - Claes H. Dohlman
- Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA
- Schepens Eye Research Institute, Boston Keratoprosthesis Laboratory/Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
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Greslechner R, Helbig H. [Neovascular Glaucomas - Pathogenesis, Diagnosis, Treatment and Prophylaxis]. Klin Monbl Augenheilkd 2023. [PMID: 37977202 DOI: 10.1055/a-2193-2448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
Neovascular glaucoma (NVG) is a severe potentially blinding disease, which represents one of the most common types of secondary glaucomas. The majority of cases are caused by ischemic retinal conditions such as diabetic retinopathy, central retinal vein occlusion or ocular ischemic syndrome. If appropriately diagnosed and treated, ideally the development of NVG can be prevented. Since treatment gets increasingly challenging as the disease progresses, early diagnosis is of utmost importance. In this review pathogenesis, diagnosis, treatment and prophylaxis are discussed extensively. A focus is put on the consecutive stages through which the disease progresses and how to diagnose and differentiate them. Ultimately a stage adapted therapy approach is detailed, consisting of the three blocks: 1. treatment of the underlying disease/retinal ischemia, 2. adjunctive medical therapy (anti-VEGF) and 3. therapy of the elevated intraocular pressure.
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Liu Q, Liu C, Cheng W, Feng X, Li H, Yang X, Dong Y. Clinical analysis of secondary glaucoma in Central China. Sci Rep 2023; 13:8439. [PMID: 37231009 DOI: 10.1038/s41598-023-34872-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Accepted: 05/09/2023] [Indexed: 05/27/2023] Open
Abstract
To describe the epidemiology, clinical and social characteristics, management, and outcomes of patients with secondary glaucoma in Central China, a total of 1,129 cases (1,158 eyes) among 710 males (62.89%) and 419 females (37.11%) were analyzed. The mean age was 53.75 ± 17.11 years. The New Rural Cooperative Medical System (NCMS) played the most important role in reimbursement (60.32%) for secondary glaucoma-related medical expenses. The predominant occupation was "farmer" (53.41%). Neovascularization and trauma were the leading causes of secondary glaucoma. Cases of trauma-induced glaucoma decreased substantially during the coronavirus disease 2019 (COVID-19) pandemic. An education level of senior high school or above was uncommon. Ahmed glaucoma valve implantation was the most commonly performed surgery. At the final follow-up, the overall intraocular pressure (IOP) in patients with vascular disease- and trauma-related secondary glaucoma was 19.53 ± 10.20 mmHg, 20.26 ± 11.75 mmHg, and 16.90 ± 6.72 mmHg, while the mean visual acuity (VA) was 0.33 ± 0.32, 0.34 ± 0.36, and 0.43 ± 0.36. In 814 (70.29%) eyes, the VA was < 0.01. Effective preventive measures for at-risk populations, increased NCMS coverage and the promotion of higher education are necessary. These findings will help ophthalmologists detect secondary glaucoma early and manage it in a timely manner.
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Affiliation(s)
- Qian Liu
- Henan Provincial People's Hospital, Henan Eye Hospital, Henan Eye Institute, Zhengzhou University People's Hospital, No. 7 Weiwu Road, Zhengzhou, 450003, Henan, China.
| | - Changgeng Liu
- Henan Provincial People's Hospital, Henan Eye Hospital, Henan Eye Institute, Zhengzhou University People's Hospital, No. 7 Weiwu Road, Zhengzhou, 450003, Henan, China
| | - Wenjun Cheng
- Henan Provincial People's Hospital, Henan Eye Hospital, Henan Eye Institute, Zhengzhou University People's Hospital, No. 7 Weiwu Road, Zhengzhou, 450003, Henan, China
| | - Xiaomei Feng
- Henan Provincial People's Hospital, Henan Eye Hospital, Henan Eye Institute, Zhengzhou University People's Hospital, No. 7 Weiwu Road, Zhengzhou, 450003, Henan, China
| | - Haijun Li
- Henan Provincial People's Hospital, Henan Eye Hospital, Henan Eye Institute, Zhengzhou University People's Hospital, No. 7 Weiwu Road, Zhengzhou, 450003, Henan, China
| | - Xiaoyuan Yang
- Henan Provincial People's Hospital, Henan Eye Hospital, Henan Eye Institute, Zhengzhou University People's Hospital, No. 7 Weiwu Road, Zhengzhou, 450003, Henan, China
| | - Yangzeng Dong
- Henan Provincial People's Hospital, Henan Eye Hospital, Henan Eye Institute, Zhengzhou University People's Hospital, No. 7 Weiwu Road, Zhengzhou, 450003, Henan, China
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Greslechner R, Helbig H. Sekundärglaukome im Rahmen retinaler Erkrankungen. Klin Monbl Augenheilkd 2022; 239:1111-1118. [PMID: 35288886 DOI: 10.1055/a-1797-5188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Zusammenfassung:
Eine Vielzahl retinaler Erkrankungen kann zur Entwicklung eines Glaukoms führen. Die häufigste Form dieser Sekundärglaukome sind die Neovaskularisationsglaukome, die den Hauptteil dieser Übersicht bilden. Dabei handelt sich um ein schwerwiegendes Krankheitsbild, dass in mehreren Stadien verläuft, wobei die Prognose mit zunehmendem Stadium ungünstiger und die Therapie herausfordernder wird. Neben Pathogenese und Diagnostik wird daher ein Schwerpunkt wird auf die Früherkennung und eine an das jeweilige Krankheitsstadium angepasste Therapie gelegt.
Auch seltenere Sekundärglaukome im Rahmen intraokularer Tumore sowie Glaukome assoziiert mit einer Netzhautablösung (Schwartz-Matsuo Syndrom) und Glaukome, die im Spätverlauf nach unkomplizierter Vitrektomie auftreten, werden in dieser Übersicht diskutiert.
Abstract:
A variety of retinal diseases can lead to the development of glaucoma. The most common type of these secondary glaucomas is neovascular glaucoma (NVG), which constitutes the main subject of this review.
NVG is a severe condition with a poor prognosis. Treatment gets increasingly challenging as the disease progresses. Thus emphasis is put on early diagnosis and an stage adjusted therapy.
Other less frequent secondary glaucomas, such as glaucomas due to intraocular tumors or associated with retinal detachment (Schwartz-Matsuo syndrome) and late onset open-angle glaucomas after uncomplicated vitrectomy are covered.
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Affiliation(s)
- Roman Greslechner
- Klinik und Poliklinik für Augenheilkunde, Universitätsklinikum Regensburg, Regensburg, Germany
| | - Horst Helbig
- Klinik und Poliklinik für Augenheilkunde, Klinikum der Universität Regensburg, Regensburg, Germany
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The Profile of Secondary Glaucoma in China: A Study of Over 10,000 Patients. J Glaucoma 2021; 30:895-901. [PMID: 34366389 DOI: 10.1097/ijg.0000000000001924] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Accepted: 07/29/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Few studies have investigated the epidemiology of secondary glaucoma (SG) in China. This study analyzed the current profile of admitted patients with SG at the largest ophthalmic center in China. METHODS SG cases were retrieved retrospectively by ICD-10 clinical coding data from January 2010 to December 2019. Demographic data, etiologies, and the management of SG were analyzed. The ratios of the etiologies were compared with previously reported data from other regions. The etiologies and management between the 2010 to 2014 group and the 2015 to 2019 group were compared. RESULTS A total of 11,730 cases were enrolled. The mean age of the patients with SG was 44.45±19.45 years old. Men (66.94%) were more vulnerable than women (33.06%). The etiologies of SG in 2010-2019 were trauma (28%), vascular disease (18%), lens-induced (9%), inflammation (11%), drug-induced (2%), anterior segment surgery (7%), posterior segment surgery (11%), syndrome-associated (4%), and tumors (1%). Compared with other regions, our data have a higher proportion of trauma and vascular disease-associated SG. Compared to 2010-2014, trauma-induced SG declined, and drug-induced SG, anterior segment surgery, and syndrome-associated SG increased in 2015-2019 (P<0.001). Vascular disease-associated SG cases were older than trauma-induced SCs and had a higher percentage in retired patients (P<0.001), whereas trauma-induced SGs were more prevalent in pediatric patients than vascular disease-related SGs (P<0.001). Additionally, the application of drainage device implantation, cataract surgery, and cyclophotocoagulation increased, whereas trabeculectomy and anterior chamber paracentesis and cyclocryotherapy decreased in 2015-2019 (P<0.005). CONCLUSION Although the etiology spectrum has changed during the last ten years, trauma and vascular disease are still common causes of SG in southern China. Traditional antiglaucoma surgery decreased gradually, and more advanced treatments emerged for its treatment. Up-to-date knowledge of SGs reflects the impact of economic development and ophthalmic service improvement on SGs and is of great value for ophthalmologists to detect SGs early and manage them in a timely manner.
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Rani PK, Sen P, Sahoo NK, Senthil S, Chakurkar R, Anup M, Behera UC, Sivaprasad S, Das T. Outcomes of neovascular glaucoma in eyes presenting with moderate to good visual potential. Int Ophthalmol 2021; 41:2359-2368. [PMID: 33745037 DOI: 10.1007/s10792-021-01789-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 03/06/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE To compare the disease characteristics and treatment outcomes of patients with neovascular glaucoma (NVG) presenting with visual acuity (VA) 6/60 or better in two different health systems. METHODS Retrospective chart review of consecutive patients with NVG who presented between January 2016 to January 2018 in 5 tertiary-centres in India and one eye-specialist centre in London (UK) was performed. The baseline characteristics, treatment provisions, and visual outcomes in the India and UK cohorts were compared. RESULTS At presentation, 18% (83 of 451) and 22% (59 of 270) of patients with NVG had VA 6/60 or better in India and the UK cohorts, respectively. The aetiologies of NVG were similar with proliferative diabetic retinopathy being the most common cause (60.9%, India; 64.4%, UK; p = 0.38). Previous panretinal photocoagulation was more prevalent in the UK cohort compared to the India cohort (94.9% versus 66.3%, respectively; p < 0.001). The mean number of intravitreal anti-VEGF injections per eye was higher in the Indian cohort (1.65 ± 0.97 versus 1.14 ± 1.02 injections; p < 0.001). The number of eyes with closed angles (36.9% India versus 30.5% UK; p = 0.45) and the number of eyes needing glaucoma interventions (52.1% India; 62.7% UK; p = 0.82) were similar in two cohorts. Among glaucoma surgeries, trabeculectomies were more commonly performed in the Indian cohort (23 vs 4; p < 0.001),while glaucoma drainage device surgeries were more prevalent in the UK cohort (18 vs 4 p < 0.001). After a median follow-up of 21 months (IQR 8.4-34.8 India; 24-36 months UK), favourable visual outcomes (vision stable or improved) were similar in both health systems (52.5% in the Indian cohort vs 43.4% in the UK cohort; p = 0.28). On multivariate regression analysis, the need for trans-scleral cyclophotocoagulation was associated with worse visual outcomes in both cohorts. CONCLUSIONS The causes and clinical profile of neovascular glaucoma with presenting visual acuity 6/60 or better in India and the UK were similar. Only up to 50% of eyes achieved favourable visual outcomes with current management protocols in both health systems.
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Affiliation(s)
- Padmaja Kumari Rani
- Srimati Kanuri Santhamma Centre for Vitreo-Retinal Diseases, Kallam Anji Reddy Campus, L V Prasad Eye Institute, Banjara Hills, Hyderabad, India.
| | - Piyali Sen
- NIHR Moorfields Biomedical Research Centre, Moorfields Eye Hospital, London, UK
| | - Niroj Kumar Sahoo
- Srimati Kanuri Santhamma Centre for Vitreo-Retinal Diseases, Kallam Anji Reddy Campus, L V Prasad Eye Institute, Banjara Hills, Hyderabad, India
| | - Sirisha Senthil
- VST Centre for Glaucoma Care, Kallam Anji Reddy Campus, L V Prasad Eye Institute, Hyderabad, India
| | - Renuka Chakurkar
- Srimati Kanuri Santhamma Centre for Vitreo-Retinal Diseases, Kallam Anji Reddy Campus, L V Prasad Eye Institute, Banjara Hills, Hyderabad, India
| | | | | | - Sobha Sivaprasad
- NIHR Moorfields Biomedical Research Centre, Moorfields Eye Hospital, London, UK
| | - Taraprasad Das
- Srimati Kanuri Santhamma Centre for Vitreo-Retinal Diseases, Kallam Anji Reddy Campus, L V Prasad Eye Institute, Banjara Hills, Hyderabad, India
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