Relationship between primary open angle glaucoma and blood pressure

Background: Glaucoma is commonly defined as high intra ocular pressure (≥21 mmHg) with optic neuropathy characterised by progressive loss of retinal ganglion cells which is associated with characteristic structural damage to the optic nerve and visual field loss. There are several studies investigating relation between primary open angle glaucoma (POAG) and both systemic hypertension and especially night hypotension. Our aim was to compare 24-h ambulatory blood pressure variability of patients with glaucoma followed-up in the eye outpatient clinic with that of patients free of glaucoma.Methods: A total of 75 patients were included in the study, 35 in the patient group and 40 in the control group. Both groups were compared for daytime, night-time, and whole day mean systolic and diastolic blood pressure (BP) readings in the ambulatory blood pressure testing.Results: Mean daytime systolic BP of the glaucoma patients was 119.5 ± 11.6 mmHg, and 128.3 ± 15.5 mmHg for control group (p = 0.008). The night-time systolic blood pressure, whole day systolic BP, and mean diastolic BP were significantly lower in patients with glaucoma (p = 0.001, p = 0.001, p = 0.028, respectively). In multiple regression analysis, we identified daytime systolic BP, night-time systolic BP, and whole day systolic BP were independent risk factors for developing glaucoma.Conclusion: If the progression of the disease is noticeable in patients with glaucoma at follow-up, night-time hypotension should be ruled out with ambulatory blood pressure and if this is observed medical treatments used by the patients should be reviewed and necessary measures should be taken.

Genome-wide association analyses identify new loci influencing intraocular pressure

Elevated intraocular pressure (IOP) is a significant risk factor for glaucoma, the leading cause of irreversible blindness worldwide. While previous studies have identified numerous genetic variants associated with IOP, these loci only explain a fraction of IOP heritability. Recently established of biobank repositories have resulted in large amounts of data, enabling the identification of the remaining heritability for complex traits. Here, we describe the largest genome-wide association study of IOP to date using participants of European ancestry from the UK Biobank. We identified 671 directly genotyped variants that are significantly associated with IOP (P < 5 × 10-8). In addition to 103 novel loci, the top ranked novel IOP genes are LMX1B, NR1H3, MADD and SEPT9. We replicated these findings in an external population and examined the pleiotropic nature of these loci. These discoveries not only further our understanding of the genetic architecture of IOP, but also shed new light on the biological processes underlying glaucoma.

Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio as Novel Biomarkers of Primary Open-Angle Glaucoma

PURPOSE

We aimed to assess the levels of neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) in patients with primary open-angle glaucoma (POAG) and to compare the NLR and PLR results of patients with POAG and ocular hypertension, as well as in healthy controls.

PATIENTS AND METHODS

Eighty-four patients with POAG, 94 patients with ocular hypertension, and 80 healthy subjects were enrolled in this retrospective study. Complete ophthalmological examination and complete blood count measurements were performed for all subjects.

RESULTS

There was a significant difference in the NLR (P=0.003) and PLR (P=0.049) between POAG and control groups. In addition, there was a correlation between pattern standard deviation and NLR in the POAG group. The receiver operating characteristics analysis revealed that the value of NLR to distinguish patients with POAG and controls was found to be 0.651. The best cutoff value was 2.1, with a sensitivity of 65% and a specificity of 65%.

CONCLUSIONS

Our study for the first time provides evidence that NLR and PLR may be useful as biomarkers in patients with POAG.

Intraocular pressure control in patients with primary open angle glaucoma and diabetes mellitus

OBJECTIVE

To determine the number of hypotensive drugs required to control the intraocular pressure (IOP) in patients with primary open angle glaucoma (POAG) and diabetes mellitus (DM), as well as describing their demographic characteristics.

DESIGN

Observational, cross-sectional, and descriptive study.

METHODS

Twenty four patients (47 eyes) with definitive diagnosis of DM and POAG were included for a six month follow up, recording demographic data and IOP control.

RESULTS

The mean age was 67.04±8.9 years, and 79% of patients were female. Mean time from diagnosis of DM was 13.87 years, and 6.21 years for POAG. No statistical difference was observed between initial and final visual acuity (P = 0.49). There was a statistical difference between initial and final IOP once treatment was started (P = 0.002), requiring 1.9 hypotensive drugs (P < 0.05). Beta-blockers were the most used hypotensive drugs for the initial (41%), as well as the final IOP control medication (28%).

CONCLUSION

The mean IOP in patients with DM and POAG was 16.8 mmHg, with the use of 1.9 hypotensive drugs.

Novel potential treatment modalities for ocular hypertension: focus on angiotensin and bradykinin system axes

Despite the availability of modern surgical procedures, new drug delivery techniques, health authority-approved single topical ocular drugs, and combination products thereof, there continues to be an unmet medical need for novel treatment modalities for preserving vision. This is especially true for the treatment of glaucoma and the high risk factor often associated with this ocular disease, elevated intraocular pressure (IOP). Undesirable local or systemic side effects, frequency of dosing, lack of sustained IOP lowering, and lack of prevention of diurnal IOP spikes are among the greatest challenges. The very recent discovery, characterization, and publication of 2 novel IOP-lowering agents that pertain to the renin-angiotensin and kallikrein-kinin axes potentially offer novel means to treat and control ocular hypertension (OHT). Here, some contextual introductory information is provided first, followed by more detailed discussion of the properties and actions of diminazene aceturate (DIZE; a novel angiotensin-converting enzyme-2 activator) and FR-190997 (a nonpeptide bradykinin receptor-2 agonist) in relation to their anti-OHT activities in rodent and cynomolgus monkey eyes, respectively. It is anticipated that these compounds will pave the way for future discovery, development, and marketing of novel drugs to treat glaucoma and thus help save sight for millions of people afflicted with this slow progressive optic neuropathy.

Improved retinal ganglion cell survival through retinal microglia suppression by a chinese herb extract, triptolide, in the DBA/2J mouse model of glaucoma

To investigate the changes in retinal microglia and retinal ganglion cell (RGC) survival after long-term administration of a Chinese herb extract, triptolide, in a DBA/2J mice. DBA/2J mice (n = 96) were administered triptolide (n = 48) 25 µg/kg or vehicle (n = 48) and were judged at 7, 9, 11 months of age. Long-term triptolide treatment tended to attenuate the anterior segment pathology in experimental group, though intraocular pressure was not significantly different between the two groups. In the experimental group, RGC survival was improved (7, 9, 11 months: p = 0.035, 0.004, 0.014), and microglia activation was suppressed based on a more ramified appearance (9, 11 months: p = 0.024, 0.013) and a lower total microglial cell count (7, 9, 11 months: p = 0.028, 0.025, 0.014). Double-immunofluorescence staining revealed TNF? localized to microglia, TNFR1 localized to the RGCs and nerve fiber layer. These findings indicate that long-term triptolide administration suppressed microglia activation and improved RGC survival in DBA/2J mice.