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Ugurel E, Narimanfar G, Cilek N, Kesim C, Altan C, Sahin A, Yalcin O. Platelet Proteome Reveals Novel Targets for Hypercoagulation in Pseudoexfoliation Syndrome. Int J Mol Sci 2024; 25:1403. [PMID: 38338682 PMCID: PMC10855978 DOI: 10.3390/ijms25031403] [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: 10/31/2023] [Revised: 12/10/2023] [Accepted: 12/13/2023] [Indexed: 02/12/2024] Open
Abstract
Pseudoexfoliation syndrome (PEX) is characterized by the accumulation of abnormal extracellular matrix material in ocular and non-ocular tissues, including blood vessel walls. Clot-forming dysfunction might be responsible for venous thrombosis in PEX. We investigated global coagulation, the proteome, and functions of platelets in PEX patients and aimed to determine prognostic biomarkers for thrombosis risk in PEX. Peripheral blood was collected from PEX and retinal vein occlusion (RVO) patients, and age-sex matched controls. Viscoelastic hemostasis was evaluated by rotational thromboelastometry (ROTEM). Platelet markers (CD41, CD42, CD61, and CD62p) and endothelial markers (P-selectin, E-selectin, and von Willebrand factor) were investigated by flow cytometry and ELISA, respectively. The platelet proteome was analyzed by 2D fluorescence difference gel electrophoresis followed by mass spectrometry. Clot formation time (CFT) is significantly reduced in PEX patients compared to the controls (p < 0.05). P-selectin levels were higher in PEX patients than in controls (p < 0.05); E-selectin and von Willebrand factor remained unchanged. The monitorization of CFT by ROTEM, and soluble P-selectin, may help assess thrombotic risk in PEX patients. Proteomic analysis revealed differential expression of Profilin-1 in platelets. Profilin-1 regulates the stability of actin-cytoskeleton and may contribute to impaired platelet hemostatic functions. Increased P-selectin levels together with impaired coagulation dynamics might be responsible for the thrombotic events in PEX disease.
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Affiliation(s)
- Elif Ugurel
- Research Center for Translational Medicine (KUTTAM), Koc University, Istanbul 34450, Turkey; (E.U.); (G.N.); (N.C.)
- Department of Physiology, School of Medicine, Koc University, Istanbul 34450, Turkey
| | - Ghazal Narimanfar
- Research Center for Translational Medicine (KUTTAM), Koc University, Istanbul 34450, Turkey; (E.U.); (G.N.); (N.C.)
| | - Neslihan Cilek
- Research Center for Translational Medicine (KUTTAM), Koc University, Istanbul 34450, Turkey; (E.U.); (G.N.); (N.C.)
- Department of Physiology, School of Medicine, Koc University, Istanbul 34450, Turkey
| | - Cem Kesim
- Department of Ophthalmology, Koc University Medical School, Istanbul 34010, Turkey; (C.K.); (A.S.)
| | - Cigdem Altan
- Beyoglu Eye Training and Research Hospital, University of Health Sciences, Istanbul 34421, Turkey;
| | - Afsun Sahin
- Department of Ophthalmology, Koc University Medical School, Istanbul 34010, Turkey; (C.K.); (A.S.)
| | - Ozlem Yalcin
- Research Center for Translational Medicine (KUTTAM), Koc University, Istanbul 34450, Turkey; (E.U.); (G.N.); (N.C.)
- Department of Physiology, School of Medicine, Koc University, Istanbul 34450, Turkey
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Ayala M. Former smoking as a risk factor for visual field progression in exfoliation glaucoma patients in Sweden. Eur J Ophthalmol 2024:11206721241226990. [PMID: 38233361 DOI: 10.1177/11206721241226990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2024]
Abstract
PURPOSE The present study aimed to identify whether former smoking was a risk factor for visual field progression in exfoliation glaucoma patients. METHODS Prospective nonrandomised cohort study. The study included patients diagnosed with exfoliation glaucoma. All included patients were followed for three years (± three months) with reliable visual fields. At least five reliable visual fields needed to be included in the study. Exfoliation glaucoma was defined using the European Glaucoma Society Guidelines. The visual fields were tested using the 24-2 test strategy of the Humphrey Field Analyzer. Smoking was assessed through questionnaires. Outcomes: Visual field progression. Three different approaches were used: difference in mean deviation (MD), rate of progression (ROP), and guided progression analysis (GPA). RESULTS In total, n = 113 patients were included; among them, n = 57 were smokers. Smoking was a significant predictor for visual field progression in the three models (MD/ROP/GPA) studied (p = 0.01/p = 0.001/p ≤ 0.001), even adjusting for intraocular pressure (IOP). Other predictors were included in the MD model: IOP at diagnosis (p = 0.04) and selective laser trabeculoplasty (SLT) treatment (p = 0.01). Other predictors were in the ROP model: Visual field index (p = 0.005), number of medications (p = 0.001) and SLT treatment (p = 0.001). The number of medications was another predictor in the GPA model (p = 0.002). CONCLUSIONS Former smoking induced visual field deterioration in all models studied. Smoking status should be considered when establishing the glaucoma diagnosis. Increased glaucoma care should be provided to former smokers to slow the progression of the disease.
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Affiliation(s)
- Marcelo Ayala
- Eye Department, Skaraborg Hospital, Sahlgrenska Academy, Gothenburg University & Karolinska Institute, Skövde, Sweden
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Hulley M, Ngcungcu T, Ramsay M, Williams S. Non-invasive harvesting of conjunctival cells for whole transcriptome sequencing. Exp Eye Res 2023; 234:109613. [PMID: 37574038 DOI: 10.1016/j.exer.2023.109613] [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: 05/17/2023] [Revised: 07/26/2023] [Accepted: 08/11/2023] [Indexed: 08/15/2023]
Abstract
The purpose of this study was to determine the feasibility of using a non-invasive technique, the EYEPRIM™ conjunctival cell impression device, to harvest sufficient RNA from conjunctival cells for the whole-transcriptome sequencing. Conjunctival cells from 40 participants were collected using an EYEPRIM™ conjunctival cell impression device. RNA was extracted from the samples, followed by library construction and transcriptome sequencing. Quality checks were performed for each technical step of the experiment, and the feasibility of this procedure was examined. RNA of sufficient yield and quality was successfully extracted following additional disruption and homogenization of the conjunctival cells and collection of two impression samples per eye. Successful library preparation and RNA sequencing were performed, with all 40 samples passing the various quality checks used for each step. In conclusion, harvesting cells from the ocular surface using an impression cytology device yields good quality and sufficient mRNA for whole transcriptome sequencing to study diseases of the eye. This technique provides a convenient alternative to using post-mortem tissues or surgical excisions.
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Affiliation(s)
- Michaella Hulley
- Division of Human Genetics, National Health Laboratory Service and School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Sydney Brenner Institute for Molecular Bioscience, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
| | - Thandiswa Ngcungcu
- Division of Human Genetics, National Health Laboratory Service and School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
| | - Michèle Ramsay
- Sydney Brenner Institute for Molecular Bioscience, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
| | - Susan Williams
- Division of Ophthalmology, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
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Łukasik U, Bartosińska J, Kosior-Jarecka E, Wróbel-Dudzińska D, Krasowska D, Żarnowski T. Results of Nailfold Videocapillaroscopy in Patients with Pseudoexfoliative Glaucoma. Life (Basel) 2023; 13:life13040967. [PMID: 37109496 PMCID: PMC10144131 DOI: 10.3390/life13040967] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 03/25/2023] [Accepted: 04/04/2023] [Indexed: 04/29/2023] Open
Abstract
The aim of this study was to evaluate the nailfold videocapillaroscopic examination results from patients with pseudoexfoliative glaucoma (XFG) and to assess the relationship between the results of this examination and the patient's clinical status in the XFG group. MATERIAL AND METHODS The studied group consisted of 39 Caucasian patients with XFG and 32 patients in a control group. The patients were classified into two subgroups: the hypertensive pseudoexfoliative glaucoma (hXFG) subgroup and the normotensive pseudoexfoliative glaucoma (nXFG) subgroup. The nailfold videocapillaroscopy (NVC) was performed on all participants. The results of each NVC were classified as having a normal or abnormal pattern. RESULTS There was no statistical difference between the results of an abnormal NVC pattern in the study group vs. the control group (p = 0.8773). Microhemorrhages were shown in 30.0% of patients with nXFG vs. the control group (6.25%) (p = 0.0520). Microhemorrhages tended to be more frequent in the XFG group (p = 0.1221). A prevalent number of tortuous capillaries was observed in hXFG patients with advanced glaucomatous neuropathy. Dilatation in the capillaries and microbleedings were observed in the group of patients with lower IOP values. Tortuosity in the capillaries was significantly more frequent in PEXG patients (XFG vs. control: p = 0.0386). No relationships between the results of NVC and age, c/d, BCVA, time of treatment, and visual field defect were found. CONCLUSIONS Specific features of NVC examination differentiate nXFG from hXFG patients. Some capillaroscopic features may correlate with the patient's clinical status of XFG.
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Affiliation(s)
- Urszula Łukasik
- Department of Diagnostics and Microsurgery of Glaucoma, Medical University of Lublin, 20-079 Lublin, Poland
| | - Joanna Bartosińska
- Department of Cosmetology and Aesthetic Medicine, Medical University of Lublin, 20-093 Lublin, Poland
| | - Ewa Kosior-Jarecka
- Department of Diagnostics and Microsurgery of Glaucoma, Medical University of Lublin, 20-079 Lublin, Poland
| | - Dominika Wróbel-Dudzińska
- Department of Diagnostics and Microsurgery of Glaucoma, Medical University of Lublin, 20-079 Lublin, Poland
| | - Dorota Krasowska
- Department of Dermatology, Venereology and Pediatric Dermatology, Medical University of Lublin, 20-093 Lublin, Poland
| | - Tomasz Żarnowski
- Department of Diagnostics and Microsurgery of Glaucoma, Medical University of Lublin, 20-079 Lublin, Poland
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Sener H, Polat OA, Sener ABG. Optic nerve head vessel density in patients with pseudoexfoliation syndrome/glaucoma: a systematic review and meta-analysis. Photodiagnosis Photodyn Ther 2023; 42:103514. [PMID: 36933675 DOI: 10.1016/j.pdpdt.2023.103514] [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: 11/14/2022] [Revised: 02/18/2023] [Accepted: 03/13/2023] [Indexed: 03/18/2023]
Abstract
PURPOSE Exfoliative material has been shown to accumulate in ocular and systemic tissues. We aimed to perform a systematic review and meta-analysis of the current literature evaluating optic nerve head vessel density (VD) using optical coherence tomography angiography (OCTA) in patients with XFS and XFG. METHODS Studies were retrieved from PubMed, Scopus, and Web of Science databases. Studies comparing patients with XFS and/or XFG patients to healthy controls, using the optic nerve head-centred 4.5 × 4.5 mm square OCTA scan protocol were included. Pooled results are presented as standardised mean differences with 95% confidence intervals (CI). Meta-regression analysis was performed between mean difference in circumpapillary VD between XFG and controls and mean pRNFL thickness in patients with XFG. RESULTS Fifteen studies with 1475 eyes were included in this review. Whole image VD and circumpapillary VD (cpVD) were significantly decreased in patients with XFS [-0.78(95% Cl: -1.08, -0.47); [-0.55(95% Cl: -0.80, -0.30); respectively] and XFG [-1.85(95% CI: -2.33, -1.36); -1.84 (95% CI: -2.30, -1.39); respectively] compared to healthy controls. Furthermore, pRNFL thickness decreased in patients with XFS [-0.55(95% Cl: -0.72, -0.35)] and XFG [-1.78(95% Cl: -2.21, -1.36)] compared to healthy controls. Meta-regression showed that pRNFL thickness decreased with increasing mean cpVD difference in XFG patients compared to healthy controls. CONCLUSIONS OCTA provides non-invasive, objective and reproducible assessment of peripapillary VD and is important for the detection of vasculopathy in patients with XFS or XFG. This study provides strong evidence for decreased cpVD in the eyes of patients with XFS and XFG.
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Affiliation(s)
- Hidayet Sener
- Department of Ophthalmology, Erciyes University Medical Faculty, Kayseri, Turkey.
| | - Osman Ahmet Polat
- Department of Ophthalmology, Erciyes University Medical Faculty, Kayseri, Turkey
| | - Ayse Busra Gunay Sener
- Department of Medical Informatics and Biostatistics, Erciyes University Medical Faculty, Kayseri, Turkey
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Naderi Beni A, Entezari D, Koosha N, Kianersi F, Naderan M. Ganglion cell complex and macular thickness layers in primary open-angle glaucoma, pseudoexfoliation glaucoma and healthy eyes: A comparative study. Photodiagnosis Photodyn Ther 2021; 36:102563. [PMID: 34614425 DOI: 10.1016/j.pdpdt.2021.102563] [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: 06/18/2021] [Revised: 08/27/2021] [Accepted: 08/30/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE To investigate the differences in the ganglion cell complex (GCC) and macular thickness measurements between primary open-angle glaucoma (POAG), pseudoexfoliation glaucoma (PXG), and healthy eyes with optical coherence tomography (OCT)optovue. METHODS In this non-randomized comparative cross-sectional study, 43 healthy eyes, 68 POAG eyes, and 57 PXG eyes were included. Patients were matched for age and disease severity. OCT angiography images were obtained for automated measurement of the GCC and macular thickness layers (inner and outer). RESULTS All GCC parameters were significantly difference between healthy and glaucomatous eyes (mild, and moderate to severe disease).There were no significant differences in GCC parameters between POAG and PXG patients except focal loss volume (FLV) after adjustment. Moderate to severe PXG eyes exhibited significantly lower GCC, larger global loss volume (GLV) values, and FLV values when compared with mild PXG eyes (p<= 0.05). We found significant thinning patterns in inner retinal thickness (fovea, parafovea, and perifovea), and total retinal thickness (parafovea, and perifovea) in moderate to severe PXG eyes when comparing with POAG eyes. Patients with moderate to severe PXG also showed significantly thinning patterns in inner retinal layers (fovea, parafovea and perifovea) and total retinal thickness (nasal parafovea) in compared to mild PXG. CONCLUSION It appears that GCC thickness is not significantly different between POAG and PXG except FLV. Despite similar retinal thickness in mild disease, a significant reduction in total and inner retinal thickness was demonstrated in moderate to severe PXG compared to moderate to severe POAG, in fovea, parafovea and perifovea region.
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Affiliation(s)
- Afsaneh Naderi Beni
- Isfahan Eye Research Center, Department of Ophthalmology, Isfahan University of Medical Sciences, Isfahan, Iran.
| | - Davoud Entezari
- Isfahan Eye Research Center, Department of Ophthalmology, Isfahan University of Medical Sciences, Isfahan, Iran.
| | - Nima Koosha
- Isfahan Eye Research Center, Department of Ophthalmology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Farzan Kianersi
- Isfahan Eye Research Center, Department of Ophthalmology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Morteza Naderan
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Lee JY, Sung KR, Kim YJ. Comparison of the Prevalence and Clinical Characteristics of Epiretinal Membrane in Pseudoexfoliation and Primary Open-angle Glaucoma. J Glaucoma 2021; 30:859-865. [PMID: 33899808 DOI: 10.1097/ijg.0000000000001851] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 03/21/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE The purpose of this study was to investigate and compare the prevalence and clinical characteristics of epiretinal membrane (ERM) in patients with pseudoexfoliation glaucoma (PXG) and primary open-angle glaucoma (POAG). METHODS In this retrospective observational study, 211 PXG eyes, 210 age-matched normal eyes, and 220 POAG eyes were included. The presence and staging of ERM (stage 1, 2, and 3 or greater) were independently assessed by 2 observers. Univariate and multivariate linear regression analyses were performed to assess the factors associated with visual field (VF) mean deviation (MD) in PXG eyes. RESULTS Among 211 PXG eyes, 40 (19.0%) had an ERM, while 4.1% of POAG and 2.4% of normal eyes had an ERM (P<0.001). Retinal nerve fiber layer thickness (69.4 vs. 70.4 μm, P=0.477) and VF MD (-7.7 vs. -10.4 dB, P=0.098) were not different between POAG and PXG eyes but macular thickness was greater (259.5 vs. 271.5 μm, P=0.006) in PXG eyes than in POAG. Both lower retinal nerve fiber layer thickness (β=0.337, P<0.001) and the presence of an ERM (β=-4.246, P=0.002) were independently associated with worse VF MD in PXG eyes. CONCLUSIONS The prevalence of ERM was significantly greater in PXG eyes than in age-matched normal or POAG eyes. The presence of ERM affected VF in PXG eyes.
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Affiliation(s)
- Jin Yeong Lee
- Department of Ophthalmology, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea
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Tangtammaruk P, Petpiroon P, Supakonatanasan W, Teekhasaenee C, Suwan Y. Peripapillary perfused capillary density in true versus pseudoexfoliation syndrome: An OCTA study. PLoS One 2020; 15:e0239109. [PMID: 33301460 PMCID: PMC7728275 DOI: 10.1371/journal.pone.0239109] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 11/24/2020] [Indexed: 11/19/2022] Open
Abstract
PURPOSE To compare peripapillary perfused capillary density (PCD) among eyes with true exfoliation syndrome (TEX), eyes with pseudoexfoliation syndrome (PEX), and healthy control eyes. MATERIALS AND METHODS In this observational cross-sectional study, eyes with and without TEX or PEX were assessed by optical coherence tomography angiography (OCTA) imaging. Bilateral OCTA images (4.5 × 4.5 mm2) centered at the optic nerve head were obtained using a commercial spectral domain OCTA system. Optic nerve head perfusion was quantified using the split-spectrum amplitude decorrelation angiography algorithm. Categorical and continuous variables were compared using the chi-squared test and one-way analysis of variance, respectively. The generalized estimating equation was used to adjust for confounding factors and determine inter-ocular associations. RESULTS We enrolled 39 eyes with TEX, 31 eyes with PEX, and 32 control eyes. There were no significant differences among the three groups regarding age, intraocular pressure, cup-to-disc ratio, blood pressure, or axial length (all p>0.05). There were significant differences in global PCD among the three groups (p = 0.01). There were significant differences in annular PCD between the TEX and PEX groups (p = 0.027). CONCLUSIONS While both global and annular PCDs did not differ between the TEX and control groups, greater loss of annular PCD in the PEX group than in the TEX and control groups suggests more pronounced microvascular disturbance in PEX. SYNOPSIS/PRECIS Greater microvascular attenuation in PEX compared with TEX and normal control measured by OCTA.
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Affiliation(s)
| | - Purit Petpiroon
- Department of Ophthalmology, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Wasu Supakonatanasan
- Department of Ophthalmology, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Chaiwat Teekhasaenee
- Department of Ophthalmology, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Yanin Suwan
- Department of Ophthalmology, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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Abstract
PRECIS In a cohort study of 120,307 participants with 25+ years of follow-up, a history of nonmelanoma skin cancer (NMSC) was associated with a 40% higher exfoliation glaucoma (XFG) risk. PURPOSE The purpose of this study was to evaluate the relationship between NMSC (a marker of ultraviolet radiation exposure) and XFG. METHODS We performed a cohort study of US women (n=79,102; 1980-2014) and men (n=41,205; 1986-2014), aged 40+ years and at risk for glaucoma who reported eye examinations. From 1984 (women)/1988 (men), we asked about basal cell carcinoma or squamous cell carcinoma history separately; in prior years, we asked about any NMSC history in a single question. Squamous cell carcinoma was confirmed with histopathology reports while basal cell carcinoma and any early (<1984/<1988) NMSC history was self-reported. Incident XFG cases (362 women and 83 men) were confirmed with medical records. Using pooled data, we estimated multivariable-adjusted relative risks [MVRRs; 95% confidence intervals (CIs)] with Cox proportional hazards models that were stratified by age (in mo), 2-year time period at risk and average lifetime residential latitude. RESULTS In multivariable-adjusted analyses, we observed a 40% higher XFG risk with any NMSC history (MVRR=1.40; 95% CI=1.08-1.82); the association was observed even with 4 and 8-year lags in NMSC history. Also, the NMSC association was stronger in younger (below 65 y; MVRR=2.56; 95% CI=1.62-4.05) versus older participants (65 y and above; MVRR=1.25; 95% CI=0.94-1.66; P for interaction=0.01) and those living in the northern latitudes (≥42°N; MVRR=1.92; 95% CI=1.28-2.88) versus more southern latitudes (<42°N; MVRR=1.19; 95% CI=0.86-1.66; P for interaction=0.04). CONCLUSION NMSC was associated with higher XFG risk, particularly among younger participants and those living in the Northern US.
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Philip S, Najafi A, Tantraworasin A, Pasquale LR, Ritch R. Nailfold Capillaroscopy of Resting Peripheral Blood Flow in Exfoliation Glaucoma and Primary Open-Angle Glaucoma. JAMA Ophthalmol 2020; 137:618-625. [PMID: 30973595 DOI: 10.1001/jamaophthalmol.2019.0434] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Importance Systemic blood flow alterations have been described using video nailfold capillaroscopy (NFC) in high-tension glaucoma (HTG) and normal-tension glaucoma (NTG) variants of primary open-angle glaucoma (POAG). To date, no previous studies have explored alterations in nailfold capillary blood flow in exfoliation glaucoma (XFG). Objective To investigate the measure of peripheral blood flow as a surrogate marker of systemic vascular involvement in patients with XFG, HTG, and NTG, as well as in individuals serving as controls, using NFC. Design, Setting, and Participants A cross-sectional clinic-based study at the New York Eye and Ear Infirmary of Mount Sinai was conducted from July 6, 2017, to May 18, 2018. A total of 111 participants (30 XFG, 30 NTG, 30 HTG, and 21 controls) received a comprehensive ophthalmic examination to confirm eligibility. Exclusion criteria were the presence of connective tissue disease, uncontrolled diabetes, history of bleeding disorders, and/or history of trauma or surgery to the nondominant hand. Main Outcomes and Measures Resting capillary blood flow at the nailfold of the fourth digit of the nondominant hand in patients with NTG, HTG, XFG, and controls, using NFC. Results Two participants were excluded owing to poor nailfold image quality, resulting in 109 participants. Sixty-two participants (57%) were women and 79 (72%) were white. Mean (SD) age of the participants was 67.9 (11.7) years. Mean (SD) resting peripheral capillary blood flow at the nailfold for controls was 70.9 (52.4) picoliters/s (pL/s); HTG, 47.5 (41.9) pL/s; NTG, 40.1 (16.6) pL/s; and XFG, 30.6 (20.0) pL/s. Multivariable analysis of the differences of flow in HTG vs control participants showed values of -18.97 (95% CI, -39.22 to 1.27; P = .07) pL/s, NTG vs controls of -25.17 (95% CI, -45.92 to -4.41; P = .02) pL/s, and XFG vs controls of -28.99 (95% CI, -51.35 to -6.63; P = .01) pL/s. Conclusions and Relevance Decreased resting peripheral capillary blood flow may occur in patients with XFG and NTG compared with individuals without glaucoma. These findings may contribute to understanding the possible systemic nature of glaucoma.
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Affiliation(s)
- Shawn Philip
- Einhorn Clinical Research Center, Department of Ophthalmology, New York Eye and Ear Infirmary of Mount Sinai, New York
| | - Ahmad Najafi
- Einhorn Clinical Research Center, Department of Ophthalmology, New York Eye and Ear Infirmary of Mount Sinai, New York
| | - Apichat Tantraworasin
- Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Louis R Pasquale
- Einhorn Clinical Research Center, Department of Ophthalmology, New York Eye and Ear Infirmary of Mount Sinai, New York.,Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Robert Ritch
- Einhorn Clinical Research Center, Department of Ophthalmology, New York Eye and Ear Infirmary of Mount Sinai, New York
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Maric V, Grgurevic A, Cirkovic A, Stankovic S, Marjanovic I, Milovanovic J, Milovanovic A, Bozic M. Nailfold capillary morphology and platelet function in patients with exfoliative glaucoma. PLoS One 2019; 14:e0219505. [PMID: 31287835 PMCID: PMC6615605 DOI: 10.1371/journal.pone.0219505] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Accepted: 06/25/2019] [Indexed: 12/13/2022] Open
Abstract
Purpose The purpose of the present study was to evaluate the nailfold capillary morphological features in patients with exfoliative glaucoma (XFG) and compare them with those pertaining to primary open-angle glaucoma (POAG), normal controls and subjects with exfoliation syndrome (XFS). The second purpose was to investigate all parameters related to platelet function on the hemogram, including the platelet count (PLT), the mean platelet volume (MPV), platelet distribution width (PDW), and plateletcrit (PCT) in patients with XFG. These parameters were subsequently compared with those belonging to normal controls, POAG and XFS subjects. Methods This case control study involved 152 consecutive patients that were examined at the Glaucoma Department of Clinic for Eye Diseases, Clinical Centre of Serbia, as the referral center for glaucoma in Serbia, between June 2016 and December 2017. Results Regarding capillaroscopic characteristics, statistically significant difference was found in capillary diameter and tortuosity between the XFG and POAG group (p = 0.050 and p = 0.035) and the XFG and NC group (p = 0.003 and p = 0.044), as well as in the distribution of capillary loops and avascular zones between the XFG and NC group (p = 0.014 and p = 0.004). The subjects with XFG had lower PLT values compared to POAG patients (p = 0.022). Conclusions In conclusion, to the best of our knowledge, this study marks the first attempt to evaluate capillary morphology as well as to investigate all parameters related to platelet function on the hemogram, in patients with newly diagnosed XFG. Our findings revealed nailfold capillary morphological vascular changes in XFG patients. The subjects with XFG had lower PLT values and a higher MPV serum parameter compared to normal controls and patients with POAG. Further research in this field should therefore aim to evaluate the consequences of the aforementioned microvascular abnormalities in patients with XFG.
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Affiliation(s)
- Vesna Maric
- Clinic for Eye Diseases, Clinical Center of Serbia, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- * E-mail:
| | - Anita Grgurevic
- Institute of Epidemiology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Andja Cirkovic
- Department for Medical Statistics and Informatics, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Sanja Stankovic
- Center for Medical Biochemistry, Clinical Center of Serbia, Belgrade, Serbia
| | - Ivan Marjanovic
- Clinic for Eye Diseases, Clinical Center of Serbia, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Jovica Milovanovic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Clinic of Otorhinolaryngology and Maxilofacial Surgery, Clinical Center of Serbia, Belgrade, Serbia
| | - Andjela Milovanovic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Clinic for Medical Rehabilitation, Clinical Center of Serbia, Belgrade, Serbia
| | - Marija Bozic
- Clinic for Eye Diseases, Clinical Center of Serbia, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
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12
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Antman G, Keren S, Kurtz S, Rosenblatt A, Rachmiel R. The Incidence of Retinal Vein Occlusion in Patients with Pseudoexfoliation Glaucoma: A Retrospective Cohort Study. Ophthalmologica 2018; 241:130-136. [PMID: 30391951 DOI: 10.1159/000492401] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Accepted: 07/23/2018] [Indexed: 01/04/2023]
Abstract
PURPOSE The aim of this study was to evaluate pseudoexfoliation (PXF) as an independent risk factor for the occurrence of retinal vein occlusion (RVO). METHODS This is a retrospective cohort study on the records of 300 PXF glaucoma patients (PXF group), 300 non-PXF glaucoma patients, and 599 nonglaucoma non-PXF (nGnP group) patients. RESULTS Multivariate analysis resulted in a significant probability for RVO in the PXF (p = 0.005; OR 2.29 [1.13-4.68]) and non-PXF glaucoma groups (p = 0.005; OR 3.03 [1.55-5.94]) compared to the nGnP group. There was a much higher probability for central RVO (CRVO) in the PXF (p = 0.013; OR 3.64 [1.39-9.49]) and non-PXF glaucoma groups (p = 0.013; OR 3.78 [1.48-9.65]) compared to the nGnP group. After matching and excluding neovascular glaucoma, no significant difference was found between the PXF and non-PXF glaucoma groups regarding RVO (p = 0.541), CRVO (p = 0.092), and branch RVO (p = 0.774). CONCLUSIONS PXF and other types of glaucoma are associated with RVOs, mainly CRVO. PXF was not found to be an independent risk factor for CRVO.
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Affiliation(s)
- Gal Antman
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shay Keren
- Department of Ophthalmology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel, .,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel,
| | - Shimon Kurtz
- Department of Ophthalmology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amir Rosenblatt
- Department of Ophthalmology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Rony Rachmiel
- Department of Ophthalmology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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13
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Koukoula SC, Katsanos A, Tentes IK, Labiris G, Kozobolis VP. Retrobulbar hemodynamics and aqueous humor levels of endothelin-1 in exfoliation syndrome and exfoliation glaucoma. Clin Ophthalmol 2018; 12:1199-1204. [PMID: 29997432 PMCID: PMC6033085 DOI: 10.2147/opth.s155551] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Background Endothelin-1 (ET-1) is the most potent vasoconstrictor in the body. There are reports in the literature correlating plasma levels of ET-1 and its impact on retrobulbar hemodynamics. This study evaluates aqueous humor levels of ET-1 and retrobulbar hemodynamics in patients with exfoliation syndrome (XFS) and exfoliation glaucoma (XFG). Patients and methods Patients scheduled for cataract surgery were included. Patients were allocated to non-exfoliation non-glaucoma group (controls), XFG and XFS groups. Peak systolic velocity (PSV), end diastolic velocity, and resistivity index of the ophthalmic artery (OA), short posterior ciliary arteries, and central retinal artery (CRA) were determined preoperatively using color Doppler imaging. Aqueous humor samples obtained at the beginning of cataract surgery were analyzed with enzyme-linked immunosorbent assay. Results Sixty-nine participants of similar age were included (controls: n=24, XFG: n=22, XFS: n=23). Multiple regression analysis showed that ET-1, OA-PSV, OA-resistivity index, CRA-PSV, and CRA-end diastolic velocity were influenced by group but not by sex or age. ET-1 for the XFG group (15.93±2.8 pg/mL) was significantly higher than for the XFS (8.92±2.7 pg/mL) and control (8.44±2.6 pg/mL) groups. The difference in ET-1 titers between the control and XFS groups was not statistically significant. All four hemodynamic parameters affected by group status significantly correlated with ET-1 levels in eyes with XFS. In eyes with XFG, two of the four hemodynamic parameters significantly correlated with ET-1 levels. In control eyes, no correlation between ET-1 and hemodynamic parameters affected by group status was detected. Conclusion ET-1 aqueous levels in eyes with XFG were significantly higher than those of age-matched controls. Reduced blood flow and increased vascular resistivity were detected in the OA and the CRA in eyes with XFG/XFS. ET-1 levels in eyes with XFG/XFS exhibit a significant correlation with hemodynamic parameters that indicate reduced perfusion.
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Affiliation(s)
- Stavroula C Koukoula
- Department of Ophthalmology, University Hospital of Alexandroupolis, Alexandroupolis, Greece, .,Eye Institute of Thrace, Alexandroupolis, Greece,
| | - Andreas Katsanos
- Eye Institute of Thrace, Alexandroupolis, Greece, .,Ophthalmology Department, University of Ioannina, Ioannina, Greece
| | - Ioannis K Tentes
- Department of Biochemistry, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Georgios Labiris
- Department of Ophthalmology, University Hospital of Alexandroupolis, Alexandroupolis, Greece, .,Eye Institute of Thrace, Alexandroupolis, Greece,
| | - Vassilios P Kozobolis
- Department of Ophthalmology, University Hospital of Alexandroupolis, Alexandroupolis, Greece, .,Eye Institute of Thrace, Alexandroupolis, Greece,
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14
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Nazarali S, Damji F, Damji KF. What have we learned about exfoliation syndrome since its discovery by John Lindberg 100 years ago? Br J Ophthalmol 2018; 102:1342-1350. [PMID: 29567789 DOI: 10.1136/bjophthalmol-2017-311321] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Revised: 02/06/2018] [Accepted: 03/07/2018] [Indexed: 12/14/2022]
Abstract
Exfoliation syndrome (XFS) is a systemic disease with significant ocular manifestations, including glaucoma and cataract. The disease impacts close to 70 million people globally and is now recognised as the most common identifiable cause of open-angle glaucoma. Since the discovery of XFS 100 years ago by Dr John G. Lindberg, there has been considerable advancement in understanding its pathogenesis and resulting clinical implications. The purpose of this paper is to summarise information regarding the epidemiology, pathophysiology, ocular manifestations and systemic associations of XFS with the objective of sharing clinical pearls to assist in early detection and enhanced management of patients.
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Affiliation(s)
- Samir Nazarali
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Faraz Damji
- School of Kinesiology, Faculty of Education, University of British Columbia, Vancouver, British Columbia, Canada
| | - Karim F Damji
- Department of Ophthalmology and Visual Sciences, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
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15
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Suwan Y, Geyman LS, Fard MA, Tantraworasin A, Chui TY, Rosen RB, Ritch R. Peripapillary Perfused Capillary Density in Exfoliation Syndrome and Exfoliation Glaucoma versus POAG and Healthy Controls: An OCTA Study. Asia Pac J Ophthalmol (Phila) 2018; 7:84-89. [PMID: 29165935 DOI: 10.22608/apo.2017318] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
PURPOSE To compare the peripapillary perfused capillary density (PCD) among eyes with exfoliation syndrome (XFS), exfoliation glaucoma (XFG), primary open-angle glaucoma (POAG), and controls. DESIGN Observational, cross-sectional study. METHODS Optical coherence tomography angiography (OCTA) images (4.5×4.5 mm) of the optic nerve head were obtained using a commercial spectral domain OCTA system (AngioVue Avanti RTVue-XR, OptoVue, Fremont, CA). Two concentric circles with 1.95-mm (inner) and 3.45-mm (outer) diameters were placed manually, producing an annulus of width 0.75 mm centered at the optic disc. PCD was calculated as the ratio of pixels associated with capillaries to the pixels in the annulus after large blood vessel removal. Continuous variables were assessed by analysis of variance and Tukey honest significant difference (HSD) test. Multiple linear regression analysis was performed to adjust for confounding factors. RESULTS Forty-three XFG eyes, 31 POAG eyes matched for visual field mean deviation, 33 XFS eyes, and 45 control eyes were analyzed. PCD demonstrated a progressive decrease from controls to XFS to POAG to XFG. Pairwise comparisons revealed significant differences in PCD between each pair of groups (all P<0.01) except for PCD between XFS and POAG (P = 0.08). A multivariable model adjusting for age and stage showed a more significant decrease in PCD in XFG compared with POAG (P = 0.001). CONCLUSIONS PCD was more significantly decreased in XFG compared with POAG eyes and in XFS compared with control eyes. OCTA provides the first quantitative evidence of the microvascular disturbance that accompanies XFS.
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Affiliation(s)
- Yanin Suwan
- Eihorn Clinical Research Center, New York Eye and Ear Infirmary of Mount Sinai, New York, NY
- Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Lawrence S Geyman
- Eihorn Clinical Research Center, New York Eye and Ear Infirmary of Mount Sinai, New York, NY
- Icahn School Medicine at Mount Sinai, New York, NY
| | | | - Apichat Tantraworasin
- Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Toco Y Chui
- Eihorn Clinical Research Center, New York Eye and Ear Infirmary of Mount Sinai, New York, NY
| | - Richard B Rosen
- Eihorn Clinical Research Center, New York Eye and Ear Infirmary of Mount Sinai, New York, NY
| | - Robert Ritch
- Eihorn Clinical Research Center, New York Eye and Ear Infirmary of Mount Sinai, New York, NY
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16
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Risk Factors Associated With Glaucomatous Progression in Pseudoexfoliation Patients. J Glaucoma 2017; 26:1107-1113. [DOI: 10.1097/ijg.0000000000000791] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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17
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Nailfold capillary morphology in exfoliation syndrome. Eye (Lond) 2017; 31:698-707. [PMID: 28085140 DOI: 10.1038/eye.2016.312] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 11/26/2016] [Indexed: 02/08/2023] Open
Abstract
PurposeThe purpose of the study was to investigate nailfold microvascular morphology in exfoliation syndrome with or without glaucoma (XFS/XFG) compared with primary open-angle glaucoma (POAG) and control subjects using nailfold capillary videomicroscopy.Patients and methodsWe used a JH-1004 capillaroscope to perform nailfold capillary videomicroscopy on the fourth and fifth digit of the non-dominant hand. We enrolled 56 XFS/XFG patients, 87 POAG patients, and 75 control subjects. Masked observers graded the videos for hemorrhages, avascular zones ≥200 microns (μm), and degree of microvascular tortuosity on a four-point subjective scale. Multivariable odds ratios, 95% confidence intervals and P-for trends for assessing the relation between morphological changes and POAG or XFS/XFG were obtained from logistic regression analyses. We also assessed this relation with XFS/XFG compared with POAG in multivariable models.ResultsAfter adjusting for multiple covariates, nailfold hemorrhages, avascular zones ≥200 μm, and higher degree of vascular tortuosity were more common in XFS/XFG vs controls (P-for trend ≤0.0001) and in POAG vs controls (P-for trend ≤0.01). For each 100 capillaries, the number of hemorrhages was similar (P-for trend=0.91) between XFS/XFG and POAG patients; however, there were more avascular zones per 100 capillaries with borderline significance (P-for trend=0.04) in the XFS/XFG group. XFS/XFG patients had more tortuosity than POAG patients; specifically, having a tortuosity score ≥1.5 was associated with a 4.4-fold increased odds of XFS/XFG (95% confidence interval: 1.5-13.3) relative to a tortuosity score <1.0 (P-for trend=0.005).ConclusionA high degree of nailfold capillary tortuosity is a distinct non-ocular feature associated with XFS/XFG compared with either POAG or controls.
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18
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de Juan-Marcos L, Escudero-Domínguez FA, Hernández-Galilea E, Cruz-González F, Follana-Neira I, González-Sarmiento R. Investigation of Association between Autophagy-Related Gene Polymorphisms and Pseudoexfoliation Syndrome and Pseudoexfoliation Glaucoma in a Spanish Population. Semin Ophthalmol 2016; 33:361-366. [DOI: 10.1080/08820538.2016.1247177] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Lourdes de Juan-Marcos
- Department of Ophthalmology, University Hospital of Salamanca, Salamanca, Spain
- Institute for Biomedical Research of Salamanca (IBSAL), Salamanca, Spain
| | | | - Emiliano Hernández-Galilea
- Department of Ophthalmology, University Hospital of Salamanca, Salamanca, Spain
- Institute for Biomedical Research of Salamanca (IBSAL), Salamanca, Spain
| | - Fernando Cruz-González
- Department of Ophthalmology, University Hospital of Salamanca, Salamanca, Spain
- Institute for Biomedical Research of Salamanca (IBSAL), Salamanca, Spain
| | - Isora Follana-Neira
- Department of Ophthalmology, University Hospital of Salamanca, Salamanca, Spain
| | - Rogelio González-Sarmiento
- Institute for Biomedical Research of Salamanca (IBSAL), Salamanca, Spain
- Molecular Medicine Unit, Department of Medicine, University of Salamanca, Salamanca, Spain
- Institute of Molecular and Cellular Biology of Cancer (BMCC), University of Salamanca-CSIC, Salamanca, Spain
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19
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Altunel O, Göktaş A, Duru N, Özköse A, Arifoğlu HB, Ataş M. The Effect of Age on Dexamethasone Intravitreal Implant (Ozurdex®) Response in Macular Edema Secondary to Branch Retinal Vein Occlusion. Semin Ophthalmol 2016; 33:179-184. [PMID: 27599562 DOI: 10.1080/08820538.2016.1188128] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE To investigate the effect of age on dexamethasone intravitreal implant (Ozurdex®) response in macular edema secondary to branch retinal vein occlusion (BRVO). METHODS Seventy-three eyes of 73 patients with macular edema secondary to BRVO were recruited in the study. The patients in the study were divided into the following four groups according to their ages: group 1 (<60 years), group 2 (60-69 years), group 3 (70-79 years), and group 4 (≥80 years). Single-dose Ozurdex injection was applied to all patients. The effectiveness of Ozurdex treatment on macular edema is evaluated via optical coherence tomography (OCT) according to the age groups. RESULTS Two months after Ozurdex injection, mean reduction of central retinal thickness in groups 1, 2, 3, and 4 were -466.4 ± 149.6, -379.7 ± 238.7, -280.1 ± 233.0, and -180.5 ± 81.4 µm, respectively. This reduction of central retinal thickness decreased with aging (p = 0.001). Also, ages of patients were negatively correlated with the mean reduction of central retinal thickness for the whole study group (r = -0.439, p < 0.001). CONCLUSION Our study revealed that the effectiveness of Ozurdex treatment decreases with aging.
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Affiliation(s)
- Orhan Altunel
- a Kayseri Education and Research Hospital , Department of Ophthalmology , Kayseri , Turkey
| | - Altan Göktaş
- a Kayseri Education and Research Hospital , Department of Ophthalmology , Kayseri , Turkey
| | - Necati Duru
- a Kayseri Education and Research Hospital , Department of Ophthalmology , Kayseri , Turkey
| | - Ayşe Özköse
- a Kayseri Education and Research Hospital , Department of Ophthalmology , Kayseri , Turkey
| | - Hasan Basri Arifoğlu
- a Kayseri Education and Research Hospital , Department of Ophthalmology , Kayseri , Turkey
| | - Mustafa Ataş
- a Kayseri Education and Research Hospital , Department of Ophthalmology , Kayseri , Turkey
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20
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Pasquale LR, Borrás T, Fingert JH, Wiggs JL, Ritch R. Exfoliation syndrome: assembling the puzzle pieces. Acta Ophthalmol 2016; 94:e505-12. [PMID: 26648185 DOI: 10.1111/aos.12918] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Accepted: 09/25/2015] [Indexed: 12/15/2022]
Abstract
PURPOSE To summarize various topics and the cutting edge approaches to refine XFS pathogenesis that were discussed at the 21st annual Glaucoma Foundation Think Tank meeting in New York City, Sept. 19-20, 2014. METHODS The highlights of three categories of talks on cutting edge research in the field were summarized. RESULTS Exfoliation syndrome (XFS) is a systemic disorder with a substantial ocular burden, including high rates of cataract, cataract surgery complications, glaucoma and retinal vein occlusion. New information about XFS is akin to puzzle pieces that do not quite join together to reveal a clear picture regarding how exfoliation material (XFM) forms. CONCLUSION Meeting participants concluded that it is unclear how the mild homocysteinemia seen in XFS might contribute to the disarrayed extracellular aggregates characteristic of this syndrome. Lysyl oxidase-like 1 (LOXL1) variants are unequivocally genetic risk factors for XFS but exactly how these variants contribute to the assembly of exfoliation material (XFM) remains unclear. Variants in a new genomic region, CACNA1A associated with XFS, may alter calcium concentrations at the cell surface and facilitate XFM formation but much more work is needed before we can place this new finding in proper context. It is hoped that various animal model and ex vivo systems will emerge that will allow for proper assembly of the puzzle pieces into a coherent picture of XFS pathogenesis. A clear understanding of XFS pathogenesis may lead to 'upstream solutions' to reduce the ocular morbidity produced by XFS.
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Affiliation(s)
- Louis R. Pasquale
- Department of Ophthalmology; Mass Eye & Ear Infirmary; Harvard Medical School; Boston Massachusetts USA
- Department of Medicine; Harvard Medical School; Brigham and Women's Hospital; Boston Massachusetts USA
| | - Terete Borrás
- Department of Ophthalmology; University of North Carolina; Chapel Hill North Carolina USA
| | - John H. Fingert
- Department of Ophthalmology and Visual Sciences; University of Iowa; Iowa City Iowa USA
| | - Janey L. Wiggs
- Department of Ophthalmology; Mass Eye & Ear Infirmary; Harvard Medical School; Boston Massachusetts USA
| | - Robert Ritch
- Einhorn Clinical Research Center; New York Eye and Ear Infirmary of Mount Sinai; New York City New York USA
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21
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Altunel O, Duru N, Goktas A, Ozkose A, Goktas E, Atas M. Evaluation of foveal photoreceptor layer in eyes with macular edema associated with branch retinal vein occlusion after ozurdex treatment. Int Ophthalmol 2016; 37:333-339. [PMID: 27221365 DOI: 10.1007/s10792-016-0261-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Accepted: 05/13/2016] [Indexed: 12/25/2022]
Abstract
The aim of this study was to evaluate the central retinal thickness (CRT), outer nuclear layer thickness (ONLT), photoreceptor layer thickness (PLT), photoreceptor layer integrity, and the correlation between visual acuity and PLT in eyes with branch retinal vein occlusion (BRVO) 2 months after treatment with intravitreal dexamethasone implant (Ozurdex; Allergan, Inc, Irvine, CA). In this prospective study, 32 eyes of 32 patients were enrolled. A single injection of Ozurdex was administered to all the patients. CRT, ONLT, and PLT were measured using spectral-domain optical coherence tomography before and 2 months after the injection. Best-corrected visual acuity (BCVA [logMAR]) and photoreceptor cell integrity were also evaluated. The average CRT, ONLT, PLT, and BCVA values for the sample group before the treatment were as follows: 707 ± 261, 608 ± 288, 70 ± 25, and 0.96 ± 0.22 µm, respectively. The average CRT, ONLT, PLT, and BCVA values for the sample group 2 months after the Ozurdex injection were as follows: 299 ± 149, 211 ± 138, 77 ± 20, and 0.63 ± 0.30 µm, respectively (p < 0.05). Two months after the Ozurdex injection, BCVA correlated with ONLT and PLT (r = 0.365, p = 0.048 and r = -0.488, p = 0.021, respectively), whereas BCVA was not correlated with CRT (r = 0.239, p = 0.189). Photoreceptor layer is associated with the visual function of eyes with macular edema secondary to BRVO. Also, ONLT seems to be more closely related to visual acuity improvement than CRT decrement.
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Affiliation(s)
- Orhan Altunel
- Department of Ophthalmology, Kayseri Education and Research Hospital, Kayseri, Turkey.
| | - Necati Duru
- Department of Ophthalmology, Kayseri Education and Research Hospital, Kayseri, Turkey
| | - Altan Goktas
- Department of Ophthalmology, Acibadem Kayseri Hospital, Kayseri, Turkey
| | - Ayse Ozkose
- Department of Ophthalmology, Kayseri Education and Research Hospital, Kayseri, Turkey
| | - Emre Goktas
- Department of Ophthalmology, Kayseri Education and Research Hospital, Kayseri, Turkey
| | - Mustafa Atas
- Department of Ophthalmology, Kayseri Education and Research Hospital, Kayseri, Turkey
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22
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Ophthalmic artery blood flow parameters in pseudoexfoliation glaucoma. Eur J Ophthalmol 2015; 26:124-7. [PMID: 26391169 DOI: 10.5301/ejo.5000671] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2015] [Indexed: 11/20/2022]
Abstract
PURPOSE To investigate orbital flow parameters of ophthalmic artery (OA) in patients with pseudoexfoliation glaucoma (XFG) by ultrasonography. METHODS This case-control study included 38 patients with XFG and 32 healthy control subjects. Color Doppler imaging was performed to evaluate orbital flow parameters of OA. Receiver operating characteristic analyses were performed to define the best cutoff value. RESULTS In the XFG group, decreased peak systolic velocity (p = 0.114), end diastolic velocity (p = 0.002), and increased resistivity index (RI) (p<0.001) at OA compared to healthy controls were observed. A cutoff value 0.72 for OA RI was found to have a sensitivity of 66% and specificity of 94%. CONCLUSIONS The results support the findings of increased vascular resistance in OA XFG. High sensitivity and specificity obtained for OA RI may be useful in evaluation of future therapeutic vascular agents.
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23
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Karagiannis D, Kontadakis GA, Klados NE, Tsoumpris I, Kandarakis AS, Parikakis EA, Georgalas I, Tsilimbaris MK. Central retinal vein occlusion and pseudoexfoliation syndrome. Clin Interv Aging 2015; 10:879-83. [PMID: 26056437 PMCID: PMC4445591 DOI: 10.2147/cia.s77630] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE The purpose of this study was to investigate the existence of pseudoexfoliation syndrome (PXF) as a risk factor for the development of central retinal vein occlusion (CRVO). METHODS This was a retrospective, comparative study of the prevalence of pseudoexfoliation in three groups of patients: 48 patients with CRVO, 164 patients with branch retinal vein occlusion (BRVO), and 70 control patients (70 eyes). All patients were phakic and had no previous diagnosis of glaucoma. Patients were matched in terms of age and systemic hypertension. All patients had normal intraocular pressure (IOP) at presentation (defined as less than or equal to 21 mmHg). RESULTS In the CRVO group, 14 out of 48 patients were diagnosed as having PXF (29.17%). In the BRVO group, 14 out of 164 patients had PXF (8.5%), and in the control group, six out of 70 patients had PXF (8.6%). Differences of percentage between groups were statistically significant (P<0.001, χ(2) test). When comparing patient subgroup with ischemic CRVO with subgroup with non-ischemic CRVO, we found that in the ischemic CRVO group, 13 out of 27 patients were diagnosed as having PXF (48.15%), and in the non-ischemic CRVO group, one out of 21 patients was diagnosed as having PXF (4.7%; P<0.001, χ(2) test). The relative odds of having CRVO in patients with PXF versus patients without PXF were 4.406 (confidence interval [CI], 2.03-9.54). CONCLUSION PXF and CRVO, especially ischemic, are strongly associated in our study. Our results indicate that PXF might be an independent factor for CRVO, as it is related with CRVO independently from glaucoma.
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Affiliation(s)
| | - Georgios A Kontadakis
- Ophthalmiatreio Eye Hospital of Athens, Athens, Greece ; Department of Ophthalmology, University Hospital of Heraklion, University of Crete, Heraklion, Greece
| | - Nektarios E Klados
- Department of Ophthalmology, University Hospital of Heraklion, University of Crete, Heraklion, Greece
| | | | | | | | - Ilias Georgalas
- Department of Ophthalmology, General Hospital of Athens, Athens, Greece
| | - Miltiadis K Tsilimbaris
- Department of Ophthalmology, University Hospital of Heraklion, University of Crete, Heraklion, Greece
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24
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Tanito M, Hara K, Akahori M, Harata A, Itabashi T, Takai Y, Kaidzu S, Ohira A, Iwata T. Lack of association of LOXL1 gene variants in Japanese patients with central retinal vein occlusion without clinically detectable pseudoexfoliation material deposits. Acta Ophthalmol 2015; 93:e214-7. [PMID: 25130441 DOI: 10.1111/aos.12534] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2014] [Accepted: 07/10/2014] [Indexed: 12/23/2022]
Abstract
PURPOSE A possible association has been reported between exfoliation syndrome (EX) and various ocular and systemic vascular disorders; however, it is unclear if there is an association between EX and central retinal vein occlusion (CRVO). Because latent deposits of exfoliation materials might not be recognized during slit-lamp examination, an ocular biopsy is required to establish a precise diagnosis. We evaluated a possible association between EX and CRVO using lysyl oxidase-like 1 (LOXL1) gene variants as alternative markers for EX. METHODS The allelic and genotypic frequencies of three LOXL1 variants (rs1048661, rs3825942, and rs2165241) were determined in 68 consecutive Japanese patients with CRVO [15 with exfoliation syndrome (EX+) and 53 without exfoliation syndrome (EX-)] and 90 control patients with cataract without EX (CT). RESULTS The frequencies of the rs1048661 and rs3825942 variants showed borderline difference between the CRVO and CT groups (p = 0.04085 and p = 0.06088, respectively, for allelic frequencies, and p = 0.06838 and p = 0.03482, respectively, for genotypic frequencies). Compared with the CT group, subgroup analysis showed that the CRVO EX+ group had significant differences in the allelic and genotypic frequencies of rs1048661 (p = 0.0006447 and p = 0.0001392, respectively) and had borderline differences in the allelic and genotypic frequencies of rs3825942 (p = 0.03403 and p = 0.07341, respectively), while the CRVO EX- group did not (p = 0.1324-0.6306). Subgroup analysis showed that the frequencies of rs2165241 did not differ between the CRVO and CT groups. CONCLUSIONS When the LOXL1 variants were used as disease markers for clinically undetectable EX, there was no association between CRVO and EX. The results suggested that the LOXL1 variants, which are well-established markers for EX, are not likely genetic markers for CRVO in Japanese subjects.
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Affiliation(s)
- Masaki Tanito
- Shimane University Faculty of Medicine Izumo Shimane Japan
- Division of Ophthalmology Matsue Red Cross Hospital Matsue Shimane Japan
| | - Katsunori Hara
- Shimane University Faculty of Medicine Izumo Shimane Japan
| | - Masakazu Akahori
- National Institute of Sensory Organs National Hospital Organization Tokyo Medical Center Tokyo Japan
| | - Ayano Harata
- National Institute of Sensory Organs National Hospital Organization Tokyo Medical Center Tokyo Japan
| | - Takeshi Itabashi
- National Institute of Sensory Organs National Hospital Organization Tokyo Medical Center Tokyo Japan
| | - Yasuyuki Takai
- Shimane University Faculty of Medicine Izumo Shimane Japan
| | - Sachiko Kaidzu
- Shimane University Faculty of Medicine Izumo Shimane Japan
| | - Akihiro Ohira
- Shimane University Faculty of Medicine Izumo Shimane Japan
| | - Takeshi Iwata
- National Institute of Sensory Organs National Hospital Organization Tokyo Medical Center Tokyo Japan
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Abstract
Exfoliation syndrome (XFS) is a systemic condition. Intraocular alterations represent only a part of the exfoliation-related clinical signs. Exfoliation material has been identified in the visceral organs, skin, and vessel walls. This triggered several studies that investigated association between XFS and cardiovascular diseases. In many populations, significant associations between XFS and various systemic vascular diseases including elevated plasma homocysteine level, myocardial dysfunction, stroke, aortic aneurysm, and white matter lesions were found. Some of these XFS-associated vascular diseases are caused by elastosis of the vessel wall, which may be directly related to general extracellular dysfunction in XFS. Another part of the pathologic vascular alterations (reduced cutaneous capillary flow reactions, impaired baroreflex sensitivity, parasympathetic cardiovascular neuropathy, and pathologic heart rate variability indices), however, suggests that vascular dysregulation beyond the age-related normal decline may also play a role both in the development and worsening of the systemic cardiovascular diseases in XFS. The exact mechanism of the development of systemic vascular dysregulation associated with XFS is currently unknown.
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Pasquale LR, Jiwani AZ, Zehavi-Dorin T, Majd A, Rhee DJ, Chen T, Turalba A, Shen L, Brauner S, Grosskreutz C, Gardiner M, Chen S, Borboli-Gerogiannis S, Greenstein SH, Chang K, Ritch R, Loomis S, Kang JH, Wiggs JL, Levkovitch-Verbin H. Solar exposure and residential geographic history in relation to exfoliation syndrome in the United States and Israel. JAMA Ophthalmol 2015; 132:1439-45. [PMID: 25188364 DOI: 10.1001/jamaophthalmol.2014.3326] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
IMPORTANCE Residential (geographic) history and extent of solar exposure may be important risk factors for exfoliation syndrome (XFS) but, to our knowledge, detailed lifetime solar exposure has not been previously evaluated in XFS. OBJECTIVE To assess the relation between residential history, solar exposure, and XFS. DESIGN, SETTING, AND PARTICIPANTS This clinic-based case-control study was conducted in the United States and Israel. It involved XFS cases and control individuals (all ≥ 60-year-old white individuals) enrolled from 2010 to 2012 (United States: 118 cases and 106 control participants; Israel: 67 cases and 72 control participants). MAIN OUTCOMES AND MEASURES Weighted lifetime average latitude of residence and average number of hours per week spent outdoors as determined by validated questionnaires. RESULTS In multivariable analyses, each degree of weighted lifetime average residential latitude away from the equator was associated with 11% increased odds of XFS (pooled odds ratio [OR], 1.11; 95% CI, 1.05-1.17; P < .001). Furthermore, every hour per week spent outdoors during the summer, averaged over a lifetime, was associated with 4% increased odds of XFS (pooled OR, 1.04; 95% CI, 1.00-1.07; P = .03). For every 1% of average lifetime summer time between 10 am and 4 pm that sunglasses were worn, the odds of XFS decreased by 2% (OR, 0.98; 95% CI, 0.97-0.99; P < .001) in the United States but not in Israel (OR, 1.00; 95% CI, 0.99-1.01; P = .92; P for heterogeneity = .005). In the United States, after controlling for important environmental covariates, history of work over water or snow was associated with increased odds of XFS (OR, 3.86; 95% CI, 1.36-10.9); in Israel, there were too few people with such history for analysis. We did not identify an association between brimmed hat wear and XFS (P > .57). CONCLUSIONS AND RELEVANCE Lifetime outdoor activities may contribute to XFS. The association with work over snow or water and the lack of association with brimmed hat wear suggests that ocular exposure to light from reflective surfaces may be an important type of exposure in XFS etiology.
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Affiliation(s)
- Louis R Pasquale
- Channing Division of Network Medicine, Department of Medicine, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts2Department of Ophthalmology, Harvard Medical School, Massachusetts Eye and Ear Infirmary, Boston
| | - Aliya Z Jiwani
- Department of Ophthalmology, Harvard Medical School, Massachusetts Eye and Ear Infirmary, Boston
| | - Tzukit Zehavi-Dorin
- Goldschleger Eye Institute, Chaim Sheba Medical Center, Tel Aviv University, Tel Hashomer, Israel
| | - Arow Majd
- Goldschleger Eye Institute, Chaim Sheba Medical Center, Tel Aviv University, Tel Hashomer, Israel
| | - Douglas J Rhee
- Department of Ophthalmology, Harvard Medical School, Massachusetts Eye and Ear Infirmary, Boston4Department of Ophthalmology and Visual Sciences, Case Western Reserve University, Cleveland, Ohio
| | - Teresa Chen
- Department of Ophthalmology, Harvard Medical School, Massachusetts Eye and Ear Infirmary, Boston
| | - Angela Turalba
- Department of Ophthalmology, Harvard Medical School, Massachusetts Eye and Ear Infirmary, Boston
| | - Lucy Shen
- Department of Ophthalmology, Harvard Medical School, Massachusetts Eye and Ear Infirmary, Boston
| | - Stacey Brauner
- Department of Ophthalmology, Harvard Medical School, Massachusetts Eye and Ear Infirmary, Boston
| | - Cynthia Grosskreutz
- Department of Ophthalmology, Harvard Medical School, Massachusetts Eye and Ear Infirmary, Boston5currently withNovartis Institute for BioMedical Research, Cambridge, Massachusetts
| | - Matthew Gardiner
- Department of Ophthalmology, Harvard Medical School, Massachusetts Eye and Ear Infirmary, Boston
| | - Sherleen Chen
- Department of Ophthalmology, Harvard Medical School, Massachusetts Eye and Ear Infirmary, Boston
| | | | - Scott H Greenstein
- Department of Ophthalmology, Harvard Medical School, Massachusetts Eye and Ear Infirmary, Boston
| | - Kenneth Chang
- Department of Ophthalmology, Harvard Medical School, Massachusetts Eye and Ear Infirmary, Boston
| | - Robert Ritch
- Einhorn Clinical Research Center, New York Eye and Ear Infirmary of Mount Sinai, New York
| | - Stephanie Loomis
- Channing Division of Network Medicine, Department of Medicine, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts
| | - Jae H Kang
- Channing Division of Network Medicine, Department of Medicine, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts
| | - Janey L Wiggs
- Department of Ophthalmology, Harvard Medical School, Massachusetts Eye and Ear Infirmary, Boston
| | - Hani Levkovitch-Verbin
- Goldschleger Eye Institute, Chaim Sheba Medical Center, Tel Aviv University, Tel Hashomer, Israel
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Abstract
PURPOSE OF REVIEW Exfoliation syndrome (XFS), the most common cause of secondary open angle glaucoma, is associated with significant ocular morbidity. Recent studies have pointed toward environmental components that may alter the risk of XFS development. This review focuses on the recent studies elucidating the role of environmental factors that play a role in the development of exfoliation syndrome. RECENT FINDINGS In XFS, aberrant microfibril formation emanating from the cell-extracellular matrix interface admixes with other macromolecules and is cross-linked by lysyl oxidase like 1 (LOXL1) activity. A common gene variant in the LOXL1 enzyme, an enzyme critical for enhancing the tensile strength of collagen and elastin in extracellular matrices, has been found in approximately 90% of XFS cases. However, approximately 80% of controls also have disease-associated LOXL1 gene variants. These findings point toward other nongenetic factors influencing the development of XFS. Increasing latitude, solar radiation, climatic variables and dietary factors such as high coffee consumption and low dietary folate intake are among the nongenetic factors associated with increased risk of XFS. SUMMARY A greater understanding of the environmental components associated with XFS may lead to lifestyle preventive strategies to ameliorate disease burden.
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Affiliation(s)
- Samantha Dewundara
- Department of Ophthalmology, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Louis R. Pasquale
- Department of Ophthalmology, Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Massachusetts Eye and Ear, Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Division of Network Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA
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Ren R, Ding J, Wang N, Teng CC, de Moraes GV, Jonas JB, Ritch R. Clinical Signs and Characteristics of Exfoliation Syndrome and Exfoliative Glaucoma in Northern China. Asia Pac J Ophthalmol (Phila) 2015; 4:86-8. [PMID: 26065350 DOI: 10.1097/apo.0000000000000106] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
PURPOSE To investigate the frequency and clinical features of exfoliation syndrome (XFS) and exfoliative glaucoma (XFG) in northern China. DESIGN A retrospective medical chart review. METHODS The review was conducted in Beijing Tongren Hospital. Using diagnosis codes, all consecutive patients with XFS/XFG were included in the study. Exfoliation syndrome was diagnosed if the patient had exfoliationmaterial (XFM) on the pupillary margin or anterior lens capsule. RESULTS Of 73,976 inpatient records, 45 patients (75 eyes) with XFS/XFG were identified (27 men, 18 women). Exfoliation syndrome/XFG accounted for 0.55% (45/8205) of hospitalized patients with cataract aged 60 years or older. The mean (SD) age of the inpatients was 72.1 (8.1) years (range, 47-85 years). Thirty-six patients had XFG, comprising 4.3% (36/838) of hospitalized patients with open-angle glaucoma. The presence of XFM on the pupillary margin (66.7%) and anterior lens surface (65.3%) were the most common features. Loss of pupillary ruff (13.3%) was uncommon. Increased pigmentation (49.3%) and flecks of XFM (9.3%) were seen on the trabecular meshwork, and 25 eyes (33.3%) had narrow angles. For those with bilateral XFS/XFG (66.7%, 30/45), 7 patients had bilateral XFS, 15 patients had bilateral XFG, and 8 patients had XFS in 1 eye but XFG in another eye. Twenty-two patients (44.4%) had hypertension, and 7 (15.6%) had ischemic heart diseases. CONCLUSIONS Exfoliation syndrome/XFG is still uncommon in the northern Chinese population. Its major clinical characteristics are the deposit of XFM on the pupil rim or anterior lens surface and increased trabecular meshwork pigmentation.
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Affiliation(s)
- Ruojin Ren
- From the *Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing, China †Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China; ‡Einhorn Clinical Research Center, New York Eye and Ear Infirmary of Mount Sinai Health System, New York, NY; and §Department of Ophthalmology, Medical Faculty Mannheim of the Ruprecht-Karls-University Heidelberg, Mannheim, Germany
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Newman-Casey PA, Stem M, Talwar N, Musch DC, Besirli CG, Stein JD. Risk factors associated with developing branch retinal vein occlusion among enrollees in a United States managed care plan. Ophthalmology 2014; 121:1939-48. [PMID: 24953793 PMCID: PMC4177949 DOI: 10.1016/j.ophtha.2014.04.045] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Revised: 01/24/2014] [Accepted: 04/29/2014] [Indexed: 12/21/2022] Open
Abstract
PURPOSE To determine risk factors associated with development of a branch retinal vein occlusion (BRVO) among a large group of managed-care plan beneficiaries in the United States. DESIGN Retrospective, longitudinal cohort study. PARTICIPANTS All beneficiaries age ≥55 years continuously enrolled for ≥2 years in a managed care network from 2001-2009 who had ≥2 visits to an eye care provider. METHODS Multivariable Cox regression analyses identified sociodemographic factors, ocular and nonocular conditions associated with incident BRVO. MAIN OUTCOME MEASURES Hazard of incident BRVO with 95% confidence interval (CI). RESULTS Of the 492,488 enrollees who met inclusion criteria, 2283 (0.5%) developed incident BRVO. After adjustment for confounding factors, blacks (adjusted hazard ratio [aHR], 1.43; CI, 1.19-1.73; P = 0.0001) had a 43% increased hazard of BRVO relative to non-Hispanic whites. Enrollees with hypertension (HTN) alone (aHR, 1.78; CI, 1.36-2.32; P < 0.0001) or HTN along with other metabolic syndrome components (diabetes mellitus [DM] and hyperlipidemia; aHR, 1.44; CI, 1.12-1.84; P = 0.005) had an increased hazard of developing a BRVO compared with those with none of these conditions. Disease severity was important; enrollees with end-organ damage caused by HTN had a 107% increased hazard of developing BRVO compared with enrollees without HTN (aHR, 2.07; CI, 1.75-2.45; P < 0.0001). Although there was no association between DM without end-organ damage and BRVO (aHR, 0.92; CI, 0.81-1.04; P = 0.2), individuals with end-organ damage from DM had a 36% increased hazard of BRVO (aHR, 1.36; CI, 1.18-1.57; P < 0.0001) compared with those without DM. Although cerebrovascular accident was associated with an increased hazard of developing BRVO (aHR, 1.34; CI, 1.19-1.52; P < 0.0001), other diseases of the vascular system (deep venous thrombosis/pulmonary embolism, peripheral vascular disease, hypercoagulable state, myocardial infarction) or anticoagulant use did not increase the risk of BRVO (P > 0.10 for all comparisons). CONCLUSIONS Both HTN and end-organ damage from DM contribute to arteriosclerosis, atherosclerosis, and endothelial dysfunction, which seem to be major risk factors for BRVO. Ophthalmologists should emphasize to patients and their primary physicians the importance of effectively managing systemic medical conditions associated with BRVO.
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Affiliation(s)
- Paula Anne Newman-Casey
- Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor, Michigan.
| | - Maxwell Stem
- Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor, Michigan
| | - Nidhi Talwar
- Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor, Michigan
| | - David C Musch
- Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor, Michigan; Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan
| | - Cagri G Besirli
- Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor, Michigan
| | - Joshua D Stein
- Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor, Michigan
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Kang JH, Wiggs JL, Pasquale LR. Relation between time spent outdoors and exfoliation glaucoma or exfoliation glaucoma suspect. Am J Ophthalmol 2014; 158:605-14.e1. [PMID: 24857689 PMCID: PMC4138242 DOI: 10.1016/j.ajo.2014.05.015] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2014] [Revised: 05/13/2014] [Accepted: 05/14/2014] [Indexed: 11/30/2022]
Abstract
PURPOSE To evaluate the relation between time spent outdoors at various life periods and risk of exfoliation glaucoma or exfoliation glaucoma suspect. DESIGN Retrospective cohort study in the United States. METHODS Participants (49 033 women in the Nurses Health Study and 20 066 men in the Health Professionals Follow-up Study) were 60+ years old, were free of glaucoma and cataract, reported eye examinations, and completed questions about time spent outdoors in direct sunlight at midday at 3 life periods: high school to age 24 years, age 25-35 years, and age 36-59 years (asked in 2006 in women and 2008 in men). Participants were followed biennially with mailed questionnaires from 1980 women/1986 men to 2010. Incident cases (223 women and 38 men) were confirmed with medical records. Cohort-specific multivariable-adjusted rate ratios from Cox proportional hazards models were estimated and pooled with meta-analysis. RESULTS Although no association was observed with greater time spent outdoors in the ages of 25-35 or ages 36-59 years, the pooled multivariable-adjusted rate ratios for ≥11 hours per week spent outdoors in high school to age 24 years compared with ≤5 hours per week was 2.00 (95% confidence interval = 1.30, 3.08; P for linear trend = .001). In women, this association was stronger in those who resided in the southern geographic tier in young adulthood (P for interaction = .07). CONCLUSIONS Greater time spent outdoors in young adulthood was associated with risk of exfoliation glaucoma or exfoliation glaucoma suspect, supporting an etiologic role of early exposures to climatic factors.
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Affiliation(s)
- Jae H Kang
- Channing Division of Network Medicine, Department of Medicine, Harvard Medical School and Brigham & Women's Hospital, Boston, Massachusetts.
| | - Janey L Wiggs
- Department of Ophthalmology, Harvard Medical School, Massachusetts Eye and Ear, Boston, Massachusetts
| | - Louis R Pasquale
- Channing Division of Network Medicine, Department of Medicine, Harvard Medical School and Brigham & Women's Hospital, Boston, Massachusetts; Department of Ophthalmology, Harvard Medical School, Massachusetts Eye and Ear, Boston, Massachusetts
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Andrikopoulos GK, Alexopoulos DK, Gartaganis SP. Pseudoexfoliation syndrome and cardiovascular diseases. World J Cardiol 2014; 6:847-854. [PMID: 25228963 PMCID: PMC4163713 DOI: 10.4330/wjc.v6.i8.847] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Revised: 04/09/2014] [Accepted: 06/11/2014] [Indexed: 02/06/2023] Open
Abstract
Pseudoexfoliation (PEX) syndrome is a well-recognized late-onset disease caused by a generalized fibrillopathy. It is linked to a broad spectrum of ocular complications including glaucoma and perioperative problems during cataract surgery. Apart from the long-known intraocular manifestations, PEX deposits have been found in a variety of extraocular locations and they appear to represent a systemic process associated with increased cardiovascular and cerebrovascular morbidity. However, as published results are inconsistent, the clinical significance of the extraocular PEX deposits remains controversial. Identification of PEX deposits in the heart and the vessel wall, epidemiologic studies, as well as, similarities in pathogenetic mechanisms have led to the hypothesis of a possible relation between fibrillar material and cardiovascular disease. Recent studies suggest that PEX syndrome is frequently linked to impaired heart and blood vessels function. Systemic and ocular blood flow changes, altered parasympathetic vascular control and baroreflex sensitivity, increased vascular resistance and decreased blood flow velocity, arterial endothelial dysfunction, high levels of plasma homocysteine and arterial hypertension have all been demonstrated in PEX subjects. Common features in the pathogenesis of both atherosclerosis and PEX, like oxidative stress and inflammation and a possible higher frequency of abdominal aorta aneurysm in PEX patients, could imply that these grey-white deposits and cardiovascular disorders are related or reflect different manifestations of the same process.
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Medical Management of Exfoliative Glaucoma. Clin Ophthalmol 2014; 54:57-70. [DOI: 10.1097/iio.0000000000000043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Bezatis A, Spital G, Höhn F, Maier M, Clemens CR, Wachtlin J, Lehmann F, Hattenbach LO, Feltgen N, Meyer CH. Functional and anatomical results after a single intravitreal Ozurdex injection in retinal vein occlusion: a 6-month follow-up -- the SOLO study. Acta Ophthalmol 2013; 91:e340-7. [PMID: 23638803 DOI: 10.1111/aos.12020] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE To evaluate the efficacy of intravitreal dexamethasone implants in eyes with cystoid macular oedema (CME) secondary to branch retinal vein occlusion (BRVO) or central retinal vein occlusion (CRVO) in the clinical everyday practice, examine the effects of early retreatment and compare the results with the GENEVA study. METHODS The charts of 102 patients (102 eyes) with CME secondary to BRVO (n = 54) or CRVO (n = 48) treated with Ozurdex at 8 centres were retrospectively reviewed. The patients were examined monthly over a 24-week period. Slit-lamp biomicroscopy, measurement of best-corrected visual acuity (BCVA) and measurement of the central retinal thickness (CRT) with spectral-domain optical coherence tomography (SD-OCT) were performed at baseline and at every follow-up examination. With progression of the disease (loss of one line or increased central retinal thickness (CRT) of 150 μm), a reinjection of Ozurdex or anti-VEGF was offered. Additional supplementing sectorial or panretinal laser photocoagulation was considered based on the individual status of the retina. RESULTS In the BRVO group, the median BCVA was 0.6 logMAR (Snellen equivalent of 0.25) at baseline and improved to 0.4 logMAR (Snellen equivalent of 0.40) after 4 weeks, 0.3 logMAR (Snellen equivalent of 0.50) after 8 weeks, 0.4 logMAR (Snellen equivalent of 0.40) after 12 weeks, 0.5 logMAR (Snellen equivalent of 0.32) after 16 weeks, 0.4 logMAR (Snellen equivalent of 0.40) after 20 weeks and 0.45 logMAR (Snellen equivalent of 0.35) after 24 weeks. The mean CRT was 559 ± (SD) 209 μm at baseline and it decreased to 335 ± 148 μm after 4 weeks, 316 ± 137 μm after 8 weeks, 369 ± 126 μm after 12 weeks, 407 ± 161 μm after 16 weeks, 399 ± 191 μm after 20 weeks and 419 ± 196 μm after 24 weeks. In the CRVO group, the median BCVA was 0.7 logMAR (Snellen equivalent of 0.20) at baseline and improved to 0.4 logMAR (Snellen equivalent of 0.40) after 4 weeks, 0.4 logMAR (Snellen equivalent of 0.40) after 8 weeks, 0.6 logMAR (Snellen equivalent of 0.25) after 12 weeks, 0.6 logMAR (Snellen equivalent of 0.25) after 16 weeks, 0.5 logMAR (Snellen equivalent of 0.32) after 20 weeks and 0.52 logMAR (Snellen equivalent of 0.30) after 24 weeks. The mean CRT at baseline was 740 ± 351 μm and it decreased to 419 ± 315 μm after 4 weeks, 352 ± 261 μm after 8 weeks, 455 ± 251 μm after 12 weeks, 497 ± 280 μm after 16 weeks, 468 ± 301 μm after 20 weeks and 395 ± 234 μm after 24 weeks. The BCVA improvement was statistically significantly better (p < 0.05) compared with baseline in both groups at every follow-up visit. The mean CRT maintained significantly better when compared with baseline in both groups at all follow-up visits. Early reinjection was indicated in BRVO in 40.7% after 17.5 ± 4.2 weeks and in CRVO in 50% after 17.68 ± 4.2. Six eyes (11%) with BRVO received a sectorial laser photocoagulation at a mean interval of 22 ± 5.0 weeks. Seven eyes (15%) with CRVO received a panretinal laser photocoagulation after a mean interval of 18 ± 7.0 weeks. The BCVA improvement and the mean CRT reduction were statistically significant (p < 0.05) compared with baseline in both groups at every follow-up visit. CONCLUSIONS Dexamethasone intravitreal implant resulted in a significant improvement of the BCVA and reduction of CME in patients with BRVO or CRVO. Early retreatment after 16 weeks instead of 24 weeks, like in the GENEVA study, was indicated in 50% to stabilize the improved functional and anatomical results.
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Azar G, Voigt M, Al-Arabi Z, Lachkar Y. Glaucomes primitifs à angle ouvert (GPAO), occlusions veineuses rétiniennes (OVR) et pachymétrie : quelle relation ? J Fr Ophtalmol 2013; 36:449-54. [DOI: 10.1016/j.jfo.2012.11.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2012] [Revised: 11/09/2012] [Accepted: 11/12/2012] [Indexed: 10/26/2022]
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Kang JH, Loomis S, Wiggs JL, Stein JD, Pasquale LR. Demographic and geographic features of exfoliation glaucoma in 2 United States-based prospective cohorts. Ophthalmology 2011; 119:27-35. [PMID: 21982415 DOI: 10.1016/j.ophtha.2011.06.018] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2011] [Revised: 06/13/2011] [Accepted: 06/15/2011] [Indexed: 12/28/2022] Open
Abstract
PURPOSE To examine prospectively the association between demographic and geographic factors in relation to exfoliation glaucoma (EG) or exfoliation glaucoma suspect (EGS). DESIGN Prospective cohort study. PARTICIPANTS Seventy-eight thousand nine hundred fifty-five women in the Nurses' Health Study and 41 191 men in the Health Professionals Follow-up Study. METHODS Female and male health professionals were followed prospectively from 1980 through 2008 and from 1986 through 2008, respectively. Eligible participants were 40 years of age or older, did not have EG or EGS at baseline, and reported undergoing eye examinations during follow-up. Information regarding demographic features, lifetime geographic residence, and potential confounders was collected. During follow-up, 348 EG or EGS cases were confirmed with medical record review. The relative risk of EG or EGS in each cohort was estimated separately and the results were pooled with meta-analysis. MAIN OUTCOME MEASURES Multivariate rate ratios (MVRRs) of EG or EGS and their 95% confidence intervals (CIs). RESULTS Exfoliation glaucoma or EGS was strongly age related with subjects 75 years of age or older at 46.22-fold (95% CI, 22.77-93.80) increased risk compared with those between 40 and 55 years of age. Although men were 68% less likely to develop EG or EGS than women (MVRR, 0.32; 95% CI, 0.23-0.46), no predisposition to EG or EGS by ancestry, particularly Scandinavian ancestry, emerged. Compared with a lifetime of living in the northern tier of the continental United States, lifetime residence in the middle geographic tier (MVRR, 0.53; 95% CI, 0.40-0.71) and in the southern geographic tier (MVRR, 0.25; 95% CI, 0.09-0.71) was associated with markedly reduced risks of EG or EGS. CONCLUSIONS In this mainly white cohort from the United States, increasing age and female gender were significant risk factors for EG or EGS; however, Scandinavian heritage was not. Living in the middle or southern regions of the United States relative to living in the northern region was associated with a reduced risk of EG or EGS. FINANCIAL DISCLOSURE(S) The author(s) have no proprietary or commercial interest in any materials discussed in this article.
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Affiliation(s)
- Jae Hee Kang
- Channing Laboratory, Department of Medicine, Harvard Medical School and Brigham & Women's Hospital, Boston, Massachusetts, USA
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Stein JD, Pasquale LR, Talwar N, Kim DS, Reed DM, Nan B, Kang JH, Wiggs JL, Richards JE. Geographic and climatic factors associated with exfoliation syndrome. ACTA ACUST UNITED AC 2011; 129:1053-60. [PMID: 21825188 DOI: 10.1001/archophthalmol.2011.191] [Citation(s) in RCA: 88] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To identify geographic and climatic risk factors associated with exfoliation syndrome (ES). METHODS A retrospective study of 626 901 eye care recipients, dating from 2001 to 2007 from 47 US states in a managed care network. Incident ES cases-patients (N = 3367) were identified by using billing codes. We assessed the risk of ES by geographic latitude tier in the continental United States and assigned state-level climatic data (eg, ambient temperature, elevation, and sun exposure) according to patients' residential location. The hazard of ES was calculated by using multivariable-adjusted Cox proportional hazards regression models. RESULTS Compared with middle-tier residence, northern-tier residence (above 42°N) was associated with an increased hazard of ES (adjusted hazard ratio [HR], 2.14; 95% confidence interval [CI], 1.94-2.35). Southern-tier (below 37°N) was associated with a reduced hazard of ES (HR, 0.83; 95% CI, 0.75-0.93). Excluding whites did not change these associations. After adjustment for joint environmental effects, for every 1° increase in July high temperature, the hazard of ES decreased by 9% (HR, 0.91; 95% CI, 0.89-0.93); for every 1° increase in January low temperature, the hazard decreased 3% (0.97; 0.96-0.98). For each additional sunny day annually, the hazard increased by 1.5% (HR, 1.02; 95% CI, 1.01-1.02) in locations with average levels of other climatic factors. CONCLUSION Ambient temperature and sun exposure may be important environmental triggers of ES.
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Affiliation(s)
- Joshua D Stein
- Department of Ophthalmology and Visual Sciences, Kellogg Eye Center, University of Michigan, Ann Arbor, 48105, USA.
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Retinal vascular occlusions occur more frequently in the more affected eye in exfoliation syndrome. Eye (Lond) 2009; 24:658-62. [DOI: 10.1038/eye.2009.152] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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