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Arimatsu M, Akagi T, Suetake A, Sakaue Y, Iikawa R, Igarashi R, Togano T, Ando T, Yoshida H, Terashima H, Fukuchi T. Intrascleral intraocular lens fixation with ab interno trabeculotomy in patients with exfoliation glaucoma with lens subluxation. Jpn J Ophthalmol 2024; 68:200-205. [PMID: 38587787 DOI: 10.1007/s10384-024-01059-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 02/21/2024] [Indexed: 04/09/2024]
Abstract
PURPOSE To evaluate the surgical outcomes of intrascleral intraocular lens (IOL) fixation using ab interno trabeculotomy (LOT) in patients with exfoliation glaucoma with lens subluxation. STUDY DESIGN Retrospective case series. METHODS Twenty eyes of 18 patients with exfoliation glaucoma and lens or IOL subluxations were included. Three success criteria were based on postoperative intraocular pressure (IOP) (A, ≤15 mmHg; B, ≤18 mmHg; C, ≤21 mmHg). The IOP, number of glaucoma medications, and visual acuity were compared before and after surgery. Success probability was analyzed using Kaplan-Meier survival curves. Cox proportional hazards' regression models were used to examine prognostic factors for surgical failure. RESULTS The mean follow-up period was 23.4 ± 7.8 months. The mean IOP significantly decreased from 23.2 ± 6.8 mmHg preoperatively to 14.0 ± 4.4 mmHg at 1 year postoperative (P<0.001). Postoperative hyphema and vitreous hemorrhage were observed in seven and 15 eyes, respectively, and washout in the anterior chamber or vitreous cavity was performed in four eyes. Postoperative IOP spikes and hypotony were observed in four eyes each. Glaucoma reoperation was performed in two eyes. The success rates at 12 months were 65%, 85%, and 90% using criteria A, B, and C, respectively. The IOP at 1 month after surgery was a significant prognostic factor for surgical failure according to criterion A (hazard ratio: 1.08; P=0.034). CONCLUSION Intrascleral IOL fixation combined with microhook LOT is a promising option in cases of exfoliation glaucoma with subluxated lens/IOL; however, the high rate of postoperative hyphema and vitreous hemorrhage should be noted.
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Affiliation(s)
- Mao Arimatsu
- Division of Ophthalmology and Visual Science, Niigata University Graduate School of Medical and Dental Sciences, 1-757, Asahimachi-dori, Chuo-ku, Niigata, 951-8510, Japan
| | - Tadamichi Akagi
- Division of Ophthalmology and Visual Science, Niigata University Graduate School of Medical and Dental Sciences, 1-757, Asahimachi-dori, Chuo-ku, Niigata, 951-8510, Japan.
| | - Aki Suetake
- Division of Ophthalmology and Visual Science, Niigata University Graduate School of Medical and Dental Sciences, 1-757, Asahimachi-dori, Chuo-ku, Niigata, 951-8510, Japan
| | - Yuta Sakaue
- Division of Ophthalmology and Visual Science, Niigata University Graduate School of Medical and Dental Sciences, 1-757, Asahimachi-dori, Chuo-ku, Niigata, 951-8510, Japan
| | - Ryu Iikawa
- Division of Ophthalmology and Visual Science, Niigata University Graduate School of Medical and Dental Sciences, 1-757, Asahimachi-dori, Chuo-ku, Niigata, 951-8510, Japan
| | - Ryoko Igarashi
- Division of Ophthalmology and Visual Science, Niigata University Graduate School of Medical and Dental Sciences, 1-757, Asahimachi-dori, Chuo-ku, Niigata, 951-8510, Japan
| | - Tetsuya Togano
- Division of Ophthalmology and Visual Science, Niigata University Graduate School of Medical and Dental Sciences, 1-757, Asahimachi-dori, Chuo-ku, Niigata, 951-8510, Japan
| | - Takumi Ando
- Division of Ophthalmology and Visual Science, Niigata University Graduate School of Medical and Dental Sciences, 1-757, Asahimachi-dori, Chuo-ku, Niigata, 951-8510, Japan
| | - Hiromitsu Yoshida
- Division of Ophthalmology and Visual Science, Niigata University Graduate School of Medical and Dental Sciences, 1-757, Asahimachi-dori, Chuo-ku, Niigata, 951-8510, Japan
| | - Hiroko Terashima
- Division of Ophthalmology and Visual Science, Niigata University Graduate School of Medical and Dental Sciences, 1-757, Asahimachi-dori, Chuo-ku, Niigata, 951-8510, Japan
| | - Takeo Fukuchi
- Division of Ophthalmology and Visual Science, Niigata University Graduate School of Medical and Dental Sciences, 1-757, Asahimachi-dori, Chuo-ku, Niigata, 951-8510, Japan
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Hondur G, Bayraktar S, Sen E, Kiziltoprak H, Doguizi S, Elgin U. Macula vessel density and its relationship with the central visual field mean sensitivity across different stages of exfoliation glaucoma. Clin Exp Optom 2024; 107:184-191. [PMID: 37844422 DOI: 10.1080/08164622.2023.2259390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Accepted: 09/12/2023] [Indexed: 10/18/2023] Open
Abstract
CLINICAL RELEVANCE Alterations in ocular microvasculature may contribute to pathogenesis of exfoliation glaucoma (XFG) and may improve monitoring this aggressive type of open angle glaucoma. BACKGROUND This work aims to compare the macula vessel density and the relationship between macula vessel density and central visual field mean sensitivity between eyes with XFG and eyes with primary open-angle glaucoma (POAG) of different stages. METHODS In this cross-sectional observational study, the macula vessel density values were compared among 52 POAG cases (26 early stage, 26 moderate to advanced stage) and 53 XFG cases (27 early stage, 26 moderate to advanced stage). The vessel density values were evaluated with optical coherence tomography angiography. Vasculature-function and structure-function relationships were analysed by comparing macula vessel density, inner macula thickness and visual field mean sensitivity in early and moderate to advanced stages of XFG and POAG eyes separately. RESULTS The early stage XFG eyes had a significantly lower global macula vessel density compared with early stage POAG eyes (42.81 ± 3.85% and 46.56 ± 3.90%, respectively; p = 0.02). However, the tendency of XFG eyes for a lower vessel density compared with the POAG eyes did not exhibit any significance in moderate to advanced stages of glaucoma (37.39 ± 5.65% and 38.35 ± 4.67%, respectively; p = 0.9). The macula vessel density (%)-visual field mean sensitivity (1/Lambert) correlation was statistically significant in early stage XFG eyes (r = 0.464 p = 0.01), while no such correlation was notable for the early stage POAG eyes (r = -0.029 p = 0.89). CONCLUSION The macula vessel density appears to be more severely affected in early stage XFG than POAG of similar severity, suggesting a relatively greater value of vascular insufficiency in XFG. The significant vasculature-function association in early stage XFG, which was absent in early stage POAG, may infer the importance of macula vessel density in monitoring functional loss in early stages of XFG.
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Affiliation(s)
- Gozde Hondur
- Ulucanlar Eye Training and Research Hospital, Department of Ophthalmology, University of Health Sciences, Ankara, Turkey
| | - Serdar Bayraktar
- Ulucanlar Eye Training and Research Hospital, Department of Ophthalmology, University of Health Sciences, Ankara, Turkey
| | - Emine Sen
- Ulucanlar Eye Training and Research Hospital, Department of Ophthalmology, University of Health Sciences, Ankara, Turkey
| | - Hasan Kiziltoprak
- Ulucanlar Eye Training and Research Hospital, Department of Ophthalmology, University of Health Sciences, Ankara, Turkey
| | - Sibel Doguizi
- Ulucanlar Eye Training and Research Hospital, Department of Ophthalmology, University of Health Sciences, Ankara, Turkey
| | - Ufuk Elgin
- Ulucanlar Eye Training and Research Hospital, Department of Ophthalmology, University of Health Sciences, Ankara, 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] [What about the content of this article? (0)] [Affiliation(s)] [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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Hanyuda A, Rosner BA, Wiggs JL, Negishi K, Pasquale LR, Kang JH. Long-term Alcohol Consumption and Risk of Exfoliation Glaucoma or Glaucoma Suspect Status among United States Health Professionals. Ophthalmology 2023; 130:187-197. [PMID: 36041586 DOI: 10.1016/j.ophtha.2022.08.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 08/19/2022] [Accepted: 08/22/2022] [Indexed: 01/25/2023] Open
Abstract
PURPOSE To assess the association between intakes of total alcohol and individual alcoholic beverages and the incidence of exfoliation glaucoma/glaucoma suspect (XFG/XFGS) status. DESIGN Prospective cohort study. PARTICIPANTS A total of 195 408 participants in the Nurses' Health Study (1980-2018), the Health Professionals Follow-up Study (1986-2018), and the Nurses' Health Study II (1991-2019) were followed biennially. Eligible participants at each 2-year risk period were ≧ 40 years and free of XFG/XFGS status with available data on diet and ophthalmic examination findings. METHODS Cumulatively averaged total (primary exposure) and individual alcoholic beverage (beer, wine, and liquor) intakes from validated dietary information every 2-4 years. MAIN OUTCOME MEASURES Confirmed incident XFG/XFGS status using medical records. We used per-eye Cox proportional hazards models, accounting for intereye correlations, to estimate multivariate-adjusted relative risks (MVRRs) and 95% confidence intervals (CIs). RESULTS During 6 877 823 eye-years of follow-up, 705 eyes with XFG/XFGS status were documented. Greater total alcohol consumption was associated significantly with higher XFG/XFGS status risk: the MVRR for XFG/XFGS status for cumulatively averaged alcohol consumption of ≧15 g/day or more versus nondrinking was 1.55 (95% CI, 1.17-2.07; P = 0.02 for trend). Long- and short-term alcohol intake was associated significantly with XFG/XFGS status risk, with the strongest associations with cumulatively averaged alcohol intake as of 4 years before diagnosis (MVRR ≥ 15 g/day vs. nondrinking, 1.65; 95% CI, 1.25-2.18; P = 0.002 for trend). Compared with nondrinkers, consuming ≧ 3.6 drinks of beer, wine, or liquor per week was associated with the following MVRRs for XFG/XFGS status: 1.26 (95% CI, 0.89-1.77; P = 0.40 for trend), 1.30 (95% CI, 1.00-1.68; P = 0.15 for trend), and 1.46 (95% CI, 1.15-1.85; P = 0.01 for trend), respectively. We did not observe interactions by age, latitude, residential tier, or intakes of folate or vitamin A (P > 0.40 for interaction); however, the association between alcohol and XFG/XFGS status was suggestively stronger for those without a family history of glaucoma (P = 0.10 for interaction). CONCLUSIONS Long-term alcohol consumption was associated with a higher risk of XFG/XFGS status. Our findings provide further clues regarding the XFG/XFGS etiology.
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Affiliation(s)
- Akiko Hanyuda
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan; Epidemiology and Prevention Group, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan.
| | - Bernard A Rosner
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Janey L Wiggs
- Department of Ophthalmology, Harvard Medical School, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts
| | - Kazuno Negishi
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
| | - Louis R Pasquale
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Jae H Kang
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
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Funagura N, Fukushima S, Inoue T. Ipilimumab-related uveitis and refractory hypotony with a flat chamber in a trabeculectomized eye with exfoliation glaucoma: A case report. Am J Ophthalmol Case Rep 2023; 29:101807. [PMID: 36714018 PMCID: PMC9876775 DOI: 10.1016/j.ajoc.2023.101807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 01/06/2023] [Accepted: 01/17/2023] [Indexed: 01/22/2023] Open
Abstract
Purpose Ipilimumab is an immune checkpoint inhibitor that occasionally causes ophthalmic immune-related adverse events (irAEs) such as dry eye, uveitis, and episcleritis. We report a case of ipilimumab-related uveitis and refractory hypotony with a flat anterior chamber (AC) in a trabeculectomized eye with exfoliation glaucoma. Observation A 69-year-old man with a history of cataract surgery and trabeculectomy for exfoliation glaucoma in the right eye presented with blurred vision at 2 months after initiation of ipilimumab for metastatic malignant melanoma (day 0). Although no ophthalmic irAEs were observed at the first visit, he developed iritis, vitreous opacity, and choroidal detachment by day 18.As a result of the irAEs, the scheduled course of ipilimumab was canceled and he was instead treated with corticosteroids (eye drops and systemic). The symptoms progressed, and on day 32 visual acuity was light perception, with a flat AC, hypotony maculopathy, and severe choroidal detachment in the right eye. The patient received two AC formations with a viscoelastic substance, but the flat AC and hypotony recurred. Because the effects of the surgeries were temporary, high doses of corticosteroids were administered. AC depth, anterior uveitis, intraocular pressure, and choroidal detachment resolved by day 91. Conclusions Ophthalmologists and oncologists should be aware of the rare but severe irAEs, and careful follow-up is required for ophthalmic irAEs caused by ipilimumab, especially in cases with a history of glaucoma surgery.
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Affiliation(s)
- Naofumi Funagura
- Department of Ophthalmology, Faculty of Life Science, Kumamoto University, 1-1-1, Honjo, Chuo-ku, Kumamoto, Japan,Corresponding author. Department of Ophthalmology, Faculty of Life Sciences, Kumamoto University, 1-1-1, Honjo, Chuo-ku, Kumamoto, Japan.
| | - Satoshi Fukushima
- Department of Dermatology and Plastic Surgery, Faculty of Life Science, Kumamoto University, 1-1-1, Honjo, Chuo-ku, Kumamoto, Japan
| | - Toshihiro Inoue
- Department of Ophthalmology, Faculty of Life Science, Kumamoto University, 1-1-1, Honjo, Chuo-ku, Kumamoto, Japan
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Wareham LK, Kuchtey J, Wu HJ, Krystofiak E, Wu Y, Reinhart-King CA, Kuchtey RW. Lysyl oxidase-like 1 deficiency alters ultrastructural and biomechanical properties of the peripapillary sclera in mice. Matrix Biol Plus 2022; 16:100120. [PMID: 36060791 DOI: 10.1016/j.mbplus.2022.100120] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 08/17/2022] [Indexed: 11/30/2022] Open
Abstract
Lysyl oxidate-like 1 knockout (Loxl1-/-) mice have decreased vision without elevated intraocular pressure. Loxl1-/- mice exhibit biometric changes of the anterior segment of the eye. Loxl1-/- mice have altered elastin and collagen structure in peripapillary sclera. Structural alternations of peripapillary sclera correlate with its increased stiffness in Loxl1-/- mice.
Lysyl oxidase-like 1 encoded by the LOXL1 gene is a member of the lysyl oxidase family of enzymes that are important in the maintenance of extracellular matrix (ECM)-rich tissue. LOXL1 is important for proper elastic fiber formation and mice lacking LOXL1 (Loxl1−/−) exhibit systemic elastic fiber disorders, such as pelvic organ prolapse, a phenotype associated with exfoliation syndrome (XFS) in humans. Patients with XFS have a significant risk of developing exfoliation glaucoma (XFG), a severe form of glaucoma, which is a neurodegenerative condition leading to irreversible blindness if not detected and treated in a timely fashion. Although Loxl1−/− mice have been used extensively to investigate mechanisms of pelvic organ prolapse, studies of eyes in those mice are limited and some showed inconsistent ocular phenotypes. In this study we demonstrate that Loxl1−/− mice have significant anterior segment biometric abnormalities which recapitulate some human XFS features. We then focused on the peripapillary sclera (PPS), a critical structure for maintaining optic nerve health. We discovered quantitative and qualitive changes in ultrastructure of PPS, such as reduced elastic fibers, enlarged collagen fibrils, and transformed collagen lamella organization detected by transmission electron microscopy (TEM). Importantly, these changes corelate with altered tissue biomechanics detected by Atomic Force Microscopy (AFM) of PPS in mice. Together, our results support a crucial role for LOXL1 in ocular tissue structure and biomechanics, and Loxl1−/− mice could be a valuable resource for understanding the role of scleral tissue biomechanics in ocular disease.
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Murakami-Kojima S, Takahashi E, Eguchi-Matsumoto M, Saruwatari J, Nakashima KI, Inoue T. Risk factors for intraocular pressure elevation in a six-month period after ab interno trabeculotomy using a Kahook Dual Blade. BMC Ophthalmol 2022; 22:327. [PMID: 35907945 PMCID: PMC9338461 DOI: 10.1186/s12886-022-02545-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 07/20/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To examine the risk factors for an early postoperative intraocular pressure (IOP) increase after ab interno trabeculotomy using a Kahook Dual Blade (KDB trabeculotomy). METHODS A retrospective study was performed in 76 exfoliation glaucoma (EXG) eyes and 56 primary open angle glaucoma (POAG) eyes that underwent KDB trabeculotomy, with or without cataract surgery at Kumamoto University Hospital. Postoperative high IOP was classified as IOP≥20 mmHg (within three months after surgery, whether persistent or temporary), transient IOP≥20 mmHg (IOP≥20 mmHg after surgery, then dropped below 20 mmHg), and the presence of IOP spikes (≥ 10 mmHg from baseline). Risk factors were examined using logistic regression analysis. RESULTS The preoperative mean IOP (SD) was 24.98 (7.23) mmHg in patients with EXG and 21.28 (6.58) mmHg in patients with POAG. IOP was reduced by 32.1% in patients with EXG and by 17.7% in patients with POAG at 6 months after surgery. Postoperative IOP≥20 mmHg was observed in 56.6% of EXG patients and in 51.8% of POAG patients. IOP spikes occurred in 15.8% of EXG patients and in 14.3% of POAG patients. Logistic regression analysis showed that factors with significant odds ratios (ORs) were age (OR = 0.866, 95% CI = 0.793-0.945), preoperative medication use (OR = 2.02, 95% CI = 1.17-3.49), trabeculotomy in combination with cataract surgery (OR = 0.0674, 95% CI = 0.015-0.303), and IOP at day 1 (OR = 1.41, 95% CI = 1.18-1.68) for postoperative IOP≥20 mmHg, the IOP at day 1 (OR = 1.1, 95% CI = 1.03-1.17) for transient IOP≥20 mmHg, and age (OR = 0.948, 95% CI = 0.901-0.997) and preoperative IOP (OR = 0.83, 95% CI = 0.736-0.936) for IOP spikes. CONCLUSION Although KDB trabeculotomy is an effective treatment for patients with EXG and POAG, patients who take multiple preoperative medications and have a high IOP on day 1 require careful follow-up to prevent postoperative IOP elevation.
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Affiliation(s)
- Setsu Murakami-Kojima
- Department of Ophthalmology, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Eri Takahashi
- Department of Ophthalmology, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan.
| | | | - Junji Saruwatari
- Department of Pharmacology and Therapeutics, Graduate School of Pharmaceutical Sciences, Kumamoto University, Kumamoto, Japan
| | - Kei-Ichi Nakashima
- Department of Ophthalmology, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Toshihiro Inoue
- Department of Ophthalmology, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
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Miura Y, Fukuda K, Fukushima A. Outcomes of flanged IOL fixation combined with microhook trabeculotomy. Int Ophthalmol 2021. [PMID: 34652544 DOI: 10.1007/s10792-021-02045-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 09/22/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate the outcomes of flanged intraocular lens fixation combined with microhook trabeculotomy. PATIENTS AND METHODS This study was a retrospective case series and included nine eyes of nine exfoliation glaucoma patients with subluxated lens or intraocular lens who underwent flanged intraocular lens fixation combined with microhook trabeculotomy between May 2019 and February 2020 at the Kochi University Hospital. The mean best-corrected visual acuity, intraocular pressure, and number of antiglaucoma medications were compared before and after surgery. RESULTS The mean follow-up period was 5.67 ± 2.50 months. The mean best-corrected visual acuity improved significantly from 0.83 ± 0.72 preoperatively to 0.22 ± 0.34 at the last visit (p = 0.015). The mean intraocular pressure had significantly reduced from 27.1 ± 8.12 mmHg preoperatively to 13.2 ± 3.73 at the last visit (p = 0.008). The mean number of antiglaucoma medications decreased significantly from 4.56 ± 1.88 to 2.0 ± 1.0 at the last visit (p = 0.008). Postoperative intraocular pressure control to 21 mmHg or lower was achieved or maintained in all patients. Postoperative vitreous hemorrhage was observed in six eyes (66.7%), two of which needed reoperation. CONCLUSIONS This study showed that flanged intraocular lens fixation combined with microhook trabeculotomy might be effective for exfoliation glaucoma with subluxated lens or intraocular lens.
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Zehavi-Dorin T, Nahum N, Ben-Artsi E, Levkovitch-Verbin H. Exfoliation syndrome: association with systemic diseases-the Maccabi glaucoma study. Graefes Arch Clin Exp Ophthalmol 2021; 259:3027-3034. [PMID: 34169352 DOI: 10.1007/s00417-021-05241-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 05/05/2021] [Accepted: 05/11/2021] [Indexed: 11/28/2022] Open
Abstract
PURPOSE To investigate the relationship between exfoliation syndrome (XFS) and systemic diseases. METHODS A population-based, retrospective study with control group was conducted using the electronic medical database of Maccabi Health Services, the second largest Health Maintenance Organization (HMO) in Israel. Study population included Maccabi members from January 2003 to April 2016. Cases consisted of patients diagnosed with XFS regardless of glaucoma. The control group included Maccabi members without XFS, matched on age, sex, and ancestry, that were examined by an ophthalmologist within the last year. MAIN OUTCOME MEASURES Associations between XFS and systemic diseases. RESULTS We identified 16,388 patients with XFS, in whom 40.3% (n = 6613) had glaucoma. The control group included 14,015 patients. Mean age was 78.3 ± 8.9 years and 76.2 ± 8.5 years for the XFS and control group, respectively. In unconditional logistic regression analyses, after adjusting for age, sex, and ancestry, XFS was significantly associated with risk of cardiovascular diseases including hypertension (OR 1.07, 95% CI 1.01-1.13, p = 0.02), myocardial infarction (OR 1.21, 95% CI 1.17-1.31, p < 0.0001), and congestive heart failure (OR 1.70, 95% CI 1.55-1.88, p < 0.0001) as well as higher risk for high creatinine (OR 1.28, 95% CI 1.2-1.37, p < 0.0001). Diabetes mellitus and body mass index were inversely associated with XFS (OR 0.70, 95% CI 0.67-0.73, p < 0.0001 and OR 0.88, 95% CI 0.84-0.93, p < 0.0001, respectively). Overall cancer diagnoses were more common in the XFS group (OR 1.05, 95% CI 1.0-1.1, p = 0.05). XFS was associated with more hospitalizations (mean 5 ± 5.3 hospitalizations in the XFS group and 3.3 ± 4.0 in the controls, p < 0.0001). CONCLUSION XFS is significantly associated with cardiovascular systemic diseases (in a population living in Israel and predominantly born in Russia).
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Affiliation(s)
- Tzukit Zehavi-Dorin
- Goldschleger Eye Institute, Sheba Medical Center, Tel Hashomer, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Nofar Nahum
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Elad Ben-Artsi
- Goldschleger Eye Institute, Sheba Medical Center, Tel Hashomer, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Hani Levkovitch-Verbin
- Goldschleger Eye Institute, Sheba Medical Center, Tel Hashomer, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Starikova D, Ponomarenko I, Reshetnikov E, Dvornyk V, Churnosov M. Novel Data about Association of the Functionally Significant Polymorphisms of the MMP9 Gene with Exfoliation Glaucoma in the Caucasian Population of Central Russia. Ophthalmic Res 2020; 64:458-464. [PMID: 33099542 DOI: 10.1159/000512507] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Accepted: 10/19/2020] [Indexed: 01/22/2023]
Abstract
AIM This study aimed to investigate the role of functionally significant polymorphisms of the MMP1, MMP3, and MMP9 genes in the development of exfoliation glaucoma (XFG) in the Caucasian population of Central Russia. METHODS The study sample consisted of 724 participants, including 328 patients with XFG and 396 individuals in the control group. The participants were of Russian ethnicity (self-reported) born in Central Russia. The participants were genotyped at 8 functionally significant polymorphisms of the MMP genes (rs3918242, rs3918249, rs17576, rs3787268, rs2250889, rs17577 MMP9, rs679620 MMP3, and rs1799750 MMP1). The association analysis was performed using logistic regression. Two polymorphisms, which were associated with XFG, and 12 polymorphisms linked to them (r2 ≥ 0.8) were analyzed for their functional significance in silico. RESULTS Allele C of rs3918249 MMP9 was associated with XFG according to the additive model (OR = 0.75, 95% CI: 0.56-0.93, pperm = 0.015), and allele G of the rs2250889 MMP9 locus was associated with XFG according to the additive (OR = 1.59, 95% CI: 1.10-2.29, pperm = 0.013) and dominant (OR = 1.68, 95% CI: 1.11-2.56, pperm = 0.016) models. Two XFG-associated loci of the MMP9 gene and 12 SNPs linked to them had a significant regulatory potential (they are located in the evolutionarily conserved regions, promoter and enhancer histone marks, the DNAase-hypersensitivity regions, a region binding to regulatory protein, and a region of regulatory motifs) and may influence the expression of 13 genes and alternative splicing of 4 genes in various tissues and organs related to the pathogenesis of XFG. CONCLUSION Allele C rs3918249 MMP9 decreased risk for XFG (OR = 0.75), and allele G of the rs2250889 MMP9 locus increased risk for XFG (OR = 1.59-1.68) in the Caucasian population of Central Russia.
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Affiliation(s)
- Dina Starikova
- Department of Medical Biological Disciplines, Belgorod State University, Belgorod, Russian Federation
| | - Irina Ponomarenko
- Department of Medical Biological Disciplines, Belgorod State University, Belgorod, Russian Federation
| | - Evgeny Reshetnikov
- Department of Medical Biological Disciplines, Belgorod State University, Belgorod, Russian Federation,
| | - Volodymyr Dvornyk
- Department of Life Sciences, College of Science and General Studies, Alfaisal University, Riyadh, Saudi Arabia
| | - Mikhail Churnosov
- Department of Medical Biological Disciplines, Belgorod State University, Belgorod, Russian Federation
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Ayala M. Comparison of visual field progression in new-diagnosed primary open-angle and exfoliation glaucoma patients in Sweden. BMC Ophthalmol 2020; 20:322. [PMID: 32758192 PMCID: PMC7404924 DOI: 10.1186/s12886-020-01592-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 07/29/2020] [Indexed: 12/01/2022] Open
Abstract
Background The present study aimed to compare visual field progression in new-diagnosed exfoliation versus open-angle glaucoma patients. Methods Retrospective study. The study included patients with new-diagnosed primary open-angle and exfoliation glaucoma. All patients were followed for 3 years with reliable visual fields. At least five reliable fields were needed for inclusion. Exfoliation and open-angle glaucoma were defined based on the European Glaucoma Society guidelines. Visual field evaluation was performed using the software threshold 24–2 of the Humphrey Field Analysis. Outcomes: Visual field progression. For visual field progression, three different strategies were used: mean deviation (MD), visual field index (VFI), and the guided progression analysis (GPA). Results The study included 128 subjects, of the 54 in the open-angle and 74 in the exfoliation glaucoma group. The MD difference values were higher in the exfoliation (− 3.17 dB) than in the primary open-angle (− 1.25 dB) glaucoma group in the three-year follow-up period. The difference between groups was significant (t-test, p = < 0.001). The difference in VFI was calculated for the 3 years follow-up period. The difference was higher in the exfoliation (− 7.65%) than in the primary open (− 1.90%) glaucoma group (t-test, p = < 0.001). The GPA showed progression in 58% of cases in exfoliation, and 13% in primary open glaucoma group (Chi-square, p = < 0.001). Conclusion The present study found a more frequent and faster visual field progression in exfoliation than in primary open-angle glaucoma patients. New-diagnosed exfoliation glaucoma patients must be controlled and treated more strictly than primary open-angle glaucoma patients to avoid visual field deterioration.
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Affiliation(s)
- Marcelo Ayala
- Eye Department, Skaraborg Hospital, Skövde, Sahlgrenska Academy, Gothenburg University & Karolinska Institute, 541 85, Skövde, Sweden.
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Schlötzer-Schrehardt U, Zenkel M. The role of lysyl oxidase-like 1 (LOXL1) in exfoliation syndrome and glaucoma. Exp Eye Res 2019; 189:107818. [PMID: 31563608 DOI: 10.1016/j.exer.2019.107818] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 09/23/2019] [Accepted: 09/25/2019] [Indexed: 12/27/2022]
Abstract
Exfoliation syndrome (XFS) is an age-related systemic disease that affects the extracellular matrix. It increases the risk of glaucoma (exfoliation glaucoma, XFG) and susceptibility to diseases of elastin-rich connective tissues. LOXL1 (lysyl oxidase-like 1) is still recognized as the major genetic effect locus in XFS and XFG in all populations worldwide, although its genetic architecture is incompletely understood. LOXL1 is a key cross-linking enzyme in elastic fiber formation and remodeling, which is compatible with the pathogenetic concept of XFS as a specific type of elastosis. This review provides an overview on the current knowledge about the role of LOXL1 in the etiology and pathophysiology of XFS and XFG. It covers the known genetic associations at the LOXL1 locus, potential mechanisms of gene regulation, implications of LOXL1 in XFS-associated fibrosis and connective tissue homeostasis, its role in the development of glaucoma and associated systemic diseases, and the currently available LOXL1-based in vivo and in vitro models. Finally, it also identifies gaps in knowledge and suggests potential areas for future research.
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Affiliation(s)
| | - Matthias Zenkel
- Department of Ophthalmology, University of Erlangen-Nürnberg, Schwabachanlage 6, 91054, Erlangen, Germany
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Noma N, Iwasa M, Young A, Ikeda M, Hsu YC, Yamamoto M, Inoue K, Imamura Y. Orofacial pain and headaches associated with exfoliation glaucoma. J Am Dent Assoc 2017; 148:936-940. [PMID: 28501097 DOI: 10.1016/j.adaj.2017.04.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Revised: 04/01/2017] [Accepted: 04/10/2017] [Indexed: 01/03/2023]
Abstract
BACKGROUND AND OVERVIEW Exfoliation syndrome is the most common identifiable cause of open-angle glaucoma. The authors report a case of exfoliation glaucoma in a patient who had orofacial pain. CASE DESCRIPTION A 77-year-old woman was treated at the orofacial pain clinic for left-sided facial pain and headaches of 7 months' duration. Her cataracts and open-angle glaucoma had been diagnosed approximately 3 years earlier. Her main symptoms were orofacial pain, eye redness, inflammation of the eyelids, and eyelid edema. Magnetic resonance imaging showed no evidence of intracranial or extracranial pathology. Hemicrania continua was considered as a possible diagnosis. Indomethacin was prescribed but did not affect her headaches. She then went to an ophthalmologist to rule out secondary headaches. Intraocular pressure was 13 millimeters of mercury in the right eye and 67 mm Hg in the left eye. The ophthalmologist made a diagnosis of exfoliation glaucoma, and the patient underwent surgical treatment for the glaucoma and cataracts. After surgery, she was free of symptoms, and intraocular pressure was 15 mm Hg in the left eye. CONCLUSIONS AND PRACTICAL IMPLICATIONS During differential diagnosis, dentists need to consider intraoral and systemic conditions that can mimic odontogenic or orofacial pain disorders in the patient's medical history and that have a higher incidence associated with the patient's age.
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Wani FR, Romana M, Singh T, Wani IR, Wani IR, Lone RA. Prevalence of Exfoliative Glaucoma among Kashmiri Population: A Hospital Based Study. Int J Health Sci (Qassim) 2009; 3:51-7. [PMID: 21475511 PMCID: PMC3068790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023] Open
Abstract
BACKGROUND The Prevalence of exfiolative glaucoma has shown extensive variation all over world ranging from 0 to 50%. OBJECTIVE To know the prevalence of exfoliative glaucoma in Kashmir. METHODS A hospital based cross-sectional study was conducted from January 2006 to January 2007 on 300 patients with documented raised intra ocular pressure (IOP), glaucomatous changes in the fundus and open angle of anterior chamber. RESULTS The study included 236 males and 64 females. Out of 300 patients, 115 had exfiolative glaucoma and among those left eye was involved in 47 patients, right eye in 31 and 37 had bilateral involvement. The patients above 60 years of age were found to have this condition more frequently as compared to those below 60 years of age. Occupation of patients had a strong association with this condition, as the disorder was seen more commonly in patients engaged in outdoor activites. The patients with exfiolative glaucoma were found to be having less Visual acuity; a higher IOP at presentation and a more severe and early optic nerve head involvement as compared to those with open angle glaucoma. CONCLUSIONS The study reveals that prevalence of exfoliative glaucoma as seen in our OPD based cross sectional study was found to be 38.3%. This prevalence was high as compared to prevalence studies conducted in southern parts of the country and low as compared to the studies conducted in the Scandinavian countries. The difference in the prevalence of the condition was probably inpart related to the differences in the climatic conditions, ethnic origin and in part related to genetic factors of the studied population.
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Affiliation(s)
- Fouzia R Wani
- Correspondence: Dr. Fouzia Rasool, Department of Ophthalmology, SMHS Hospital, Government Medical College, Srinagar – 190010 (India),
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