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Wang X, Jiang X, Liu Z, Wang C, Li X. Coexistence of MRCS syndrome, extremely long axis and exfoliation syndrome: a case report and literature review. BMC Ophthalmol 2023; 23:241. [PMID: 37254066 DOI: 10.1186/s12886-023-02965-7] [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] [Received: 04/25/2022] [Accepted: 05/05/2023] [Indexed: 06/01/2023] Open
Abstract
BACKGROUND The coexistence of MRCS (microcornea, retinal dystrophy, cataract, and posterior staphyloma) syndrome and extremely long axis is rare since microcornea frequently accompanies with diminution of entire anterior segment and occasionally the whole globe. In the case presented here, combination of these two elements were identified, together with XFS (exfoliation syndrome). CASE PRESENTATION A 66-year-old Han Chinese woman presented for consultation due to impaired vision which accompanied throughout her entire life span and worsened during the last 2 years. Combination of MRCS syndrome and extremely long axial length was evidently diagnosed in both eyes, with XFS confirmed in her right eye, but mutation screening failed to identify disease-causing sequence variants in some specific genes reported previously, including BEST1 and ARL2. However, likely pathogenic mutations in FBN2 gene were identified. Bilateral cataract phacoemulsification without intraocular lens implantation was performed using scleral tunnel incision and under general anesthesia. At 3-month follow-up, ocular recovery of the patient was satisfactory. CONCLUSIONS The case presented here exhibited rare coexistence of MRCS syndrome, extremely long axis and XFS. The complexity of her ocular abnormalities brought challenges to surgical management, in which multidisciplinary collaboration is often required. Furthermore, the genetic analysis in this case yielded a possible novel candidate gene for MRCS syndrome and provided evidence in support of genetic heterogeneity in this phenotype.
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Affiliation(s)
- Xinglin Wang
- Department of Ophthalmology, Peking University Third Hospital, Haidian District, 49 North Garden Road, Beijing, China
- Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Haidian District, 49 North Garden Road, Beijing, China
| | - Xiaodan Jiang
- Department of Ophthalmology, Peking University Third Hospital, Haidian District, 49 North Garden Road, Beijing, China
- Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Haidian District, 49 North Garden Road, Beijing, China
| | - Ziyuan Liu
- Department of Ophthalmology, Peking University Third Hospital, Haidian District, 49 North Garden Road, Beijing, China
- Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Haidian District, 49 North Garden Road, Beijing, China
| | - Changguan Wang
- Department of Ophthalmology, Peking University Third Hospital, Haidian District, 49 North Garden Road, Beijing, China.
- Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Haidian District, 49 North Garden Road, Beijing, China.
| | - Xuemin Li
- Department of Ophthalmology, Peking University Third Hospital, Haidian District, 49 North Garden Road, Beijing, China.
- Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Haidian District, 49 North Garden Road, Beijing, China.
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Hirbo JB, Pasutto F, Gamazon ER, Evans P, Pawar P, Berner D, Sealock J, Tao R, Straub PS, Konkashbaev AI, Breyer MA, Schlötzer-Schrehardt U, Reis A, Brantley MA, Khor CC, Joos KM, Cox NJ. Analysis of genetically determined gene expression suggests role of inflammatory processes in exfoliation syndrome. BMC Genomics 2023; 24:75. [PMID: 36797672 PMCID: PMC9936777 DOI: 10.1186/s12864-023-09179-7] [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: 06/20/2022] [Accepted: 02/09/2023] [Indexed: 02/18/2023] Open
Abstract
BACKGROUND Exfoliation syndrome (XFS) is an age-related systemic disorder characterized by excessive production and progressive accumulation of abnormal extracellular material, with pathognomonic ocular manifestations. It is the most common cause of secondary glaucoma, resulting in widespread global blindness. The largest global meta-analysis of XFS in 123,457 multi-ethnic individuals from 24 countries identified seven loci with the strongest association signal in chr15q22-25 region near LOXL1. Expression analysis have so far correlated coding and a few non-coding variants in the region with LOXL1 expression levels, but functional effects of these variants is unclear. We hypothesize that analysis of the contribution of the genetically determined component of gene expression to XFS risk can provide a powerful method to elucidate potential roles of additional genes and clarify biology that underlie XFS. RESULTS Transcriptomic Wide Association Studies (TWAS) using PrediXcan models trained in 48 GTEx tissues leveraging on results from the multi-ethnic and European ancestry GWAS were performed. To eliminate the possibility of false-positive results due to Linkage Disequilibrium (LD) contamination, we i) performed PrediXcan analysis in reduced models removing variants in LD with LOXL1 missense variants associated with XFS, and variants in LOXL1 models in both multiethnic and European ancestry individuals, ii) conducted conditional analysis of the significant signals in European ancestry individuals, and iii) filtered signals based on correlated gene expression, LD and shared eQTLs, iv) conducted expression validation analysis in human iris tissues. We observed twenty-eight genes in chr15q22-25 region that showed statistically significant associations, which were whittled down to ten genes after statistical validations. In experimental analysis, mRNA transcript levels for ARID3B, CD276, LOXL1, NEO1, SCAMP2, and UBL7 were significantly decreased in iris tissues from XFS patients compared to control samples. TWAS genes for XFS were significantly enriched for genes associated with inflammatory conditions. We also observed a higher incidence of XFS comorbidity with inflammatory and connective tissue diseases. CONCLUSION Our results implicate a role for connective tissues and inflammation pathways in the etiology of XFS. Targeting the inflammatory pathway may be a potential therapeutic option to reduce progression in XFS.
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Affiliation(s)
- Jibril B. Hirbo
- grid.152326.10000 0001 2264 7217Genetic Medicine, Vanderbilt University School of Medicine, Nashville, TN 37232 USA ,Vanderbilt Genetics Institute, Nashville, TN 37232 USA
| | - Francesca Pasutto
- grid.5330.50000 0001 2107 3311Institute of Human Genetics, Friedrich-Alexander-Universität Erlangen-Nürnberg FAU, 91054 Erlangen, Germany
| | - Eric R. Gamazon
- grid.152326.10000 0001 2264 7217Genetic Medicine, Vanderbilt University School of Medicine, Nashville, TN 37232 USA ,Vanderbilt Genetics Institute, Nashville, TN 37232 USA ,grid.5335.00000000121885934Clare Hall and MRC Epidemiology Unit, University of Cambridge, Cambridge, CB2 0SL UK
| | - Patrick Evans
- grid.152326.10000 0001 2264 7217Genetic Medicine, Vanderbilt University School of Medicine, Nashville, TN 37232 USA
| | - Priyanka Pawar
- grid.412807.80000 0004 1936 9916Vanderbilt Eye Institute, Vanderbilt University Medical Center, Nashville, TN 37232 USA
| | - Daniel Berner
- grid.5330.50000 0001 2107 3311Department of Ophthalmology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, 91054 Erlangen, Germany
| | - Julia Sealock
- grid.152326.10000 0001 2264 7217Genetic Medicine, Vanderbilt University School of Medicine, Nashville, TN 37232 USA
| | - Ran Tao
- grid.152326.10000 0001 2264 7217Biostatistics, Vanderbilt University School of Medicine, Nashville, TN 37232 USA
| | - Peter S. Straub
- grid.152326.10000 0001 2264 7217Genetic Medicine, Vanderbilt University School of Medicine, Nashville, TN 37232 USA
| | - Anuar I. Konkashbaev
- grid.152326.10000 0001 2264 7217Genetic Medicine, Vanderbilt University School of Medicine, Nashville, TN 37232 USA
| | - Max A. Breyer
- grid.152326.10000 0001 2264 7217Genetic Medicine, Vanderbilt University School of Medicine, Nashville, TN 37232 USA
| | - Ursula Schlötzer-Schrehardt
- grid.5330.50000 0001 2107 3311Department of Ophthalmology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, 91054 Erlangen, Germany
| | - André Reis
- grid.5330.50000 0001 2107 3311Institute of Human Genetics, Friedrich-Alexander-Universität Erlangen-Nürnberg FAU, 91054 Erlangen, Germany
| | - Milam A. Brantley
- grid.5335.00000000121885934Clare Hall and MRC Epidemiology Unit, University of Cambridge, Cambridge, CB2 0SL UK
| | - Chiea C. Khor
- grid.418377.e0000 0004 0620 715XGenome Institute of Singapore, 60 Biopolis St, Singapore, 138672 Singapore
| | - Karen M. Joos
- grid.412807.80000 0004 1936 9916Vanderbilt Eye Institute, Vanderbilt University Medical Center, Nashville, TN 37232 USA
| | - Nancy J. Cox
- grid.152326.10000 0001 2264 7217Genetic Medicine, Vanderbilt University School of Medicine, Nashville, TN 37232 USA ,Vanderbilt Genetics Institute, Nashville, TN 37232 USA
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Huang JJ, Geduldig JE, Jacobs EB, Tai TYT, Ahmad S, Chadha N, Buxton DF, Vinod K, Wirostko BM, Kang JH, Wiggs JL, Ritch R, Pasquale LR. Head and Neck Region Dermatological Ultraviolet-Related Cancers are Associated with Exfoliation Syndrome in a Clinic-Based Population. Ophthalmol Glaucoma 2022; 5:663-671. [PMID: 35470101 PMCID: PMC9587131 DOI: 10.1016/j.ogla.2022.04.002] [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: 02/12/2022] [Revised: 04/12/2022] [Accepted: 04/18/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVE We assessed the relationship between ultraviolet (UV)-associated dermatological carcinomas (basal cell carcinoma [BCC] and squamous cell carcinoma [SCC]) and exfoliation syndrome (XFS) or exfoliation glaucoma (XFG). DESIGN Case-control study. PARTICIPANTS Between 2019 and 2021, 321 participants and control subjects (XFS or XFG = 98; primary open-angle glaucoma [POAG] = 117; controls = 106; ages 50-90 years) were recruited. METHODS A cross-sectional survey assessing medical history, maximum known intraocular pressure, cup-to-disc ratio, Humphrey visual field 24-2, the propensity to tan or burn in early life, history of BCC or SCC, and XFS or XFG diagnosis. The multivariable models adjusted for age, sex, medical history, eye color, hair color, and likeliness of tanning versus burning at a young age. MAIN OUTCOME MEASURES History of diagnosed XFS or XFG. RESULTS Any history of BCC or SCC in the head and neck region was associated with a 2-fold higher risk of having XFS or XFG versus having POAG or being a control subject (odds ratio [OR], 2.01; 95% confidence interval [CI], 1.04-3.89) in a multivariable-adjusted analysis. We observed a dose-response association in which the chance of having XFS or XFG increased by 67% per head and neck BCC or SCC occurrence (OR, 1.67; 95% CI, 1.09-2.56). When we excluded POAG participants, head and neck BCC or SCC was associated with a 2.8-fold higher risk of XFS or XFG (OR, 2.80; 95% CI, 1.12-7.02), and each additional occurrence had a 2-fold higher risk of XFS or XFG (OR, 1.97; 95% CI, 1.09-3.58). The association between head and neck region BCC or SCC and POAG compared with the control subjects was null (OR, 1.42; 95% CI, 0.58-3.48). With BCC or SCC located anywhere on the body, there was a nonsignificantly higher risk of having XFS or XFG compared with having POAG or being a control subject (OR, 1.65; 95% CI, 0.88-3.09). CONCLUSIONS Head and neck region BCCs or SCCs are associated with a higher risk of having XFS or XFG. These findings support prior evidence that head and neck UV exposure may be a risk factor for XFS.
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Affiliation(s)
- Jeff J Huang
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, New York.
| | - Jack E Geduldig
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Erica B Jacobs
- New York Eye and Ear Infirmary of Mount Sinai, New York, New York
| | - Tak Yee T Tai
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, New York; New York Eye and Ear Infirmary of Mount Sinai, New York, New York
| | - Sumayya Ahmad
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, New York; New York Eye and Ear Infirmary of Mount Sinai, New York, New York
| | - Nisha Chadha
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, New York; New York Eye and Ear Infirmary of Mount Sinai, New York, New York
| | - Douglas F Buxton
- New York Eye and Ear Infirmary of Mount Sinai, New York, New York
| | - Kateki Vinod
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, New York; New York Eye and Ear Infirmary of Mount Sinai, New York, New York
| | | | - Jae H Kang
- Channing Division of Network of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Janey L Wiggs
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts
| | - Robert Ritch
- New York Eye and Ear Infirmary of Mount Sinai, New York, New York
| | - Louis R Pasquale
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, New York; New York Eye and Ear Infirmary of Mount Sinai, New York, New York
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Ghaffari Sharaf M, Waduthanthri KD, Crichton A, Damji KF, Unsworth LD. Towards preventing exfoliation glaucoma by targeting and removing fibrillar aggregates associated with exfoliation syndrome. J Nanobiotechnology 2022; 20:459. [PMID: 36303134 DOI: 10.1186/s12951-022-01665-6] [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: 03/18/2022] [Accepted: 10/02/2022] [Indexed: 11/10/2022] Open
Abstract
Exfoliation syndrome presents as an accumulation of insoluble fibrillar aggregates that commonly correlates with age and causes ocular complications, most notably open-angle glaucoma. Despite advances in understanding the pathogenesis and risk factors associated with exfoliation syndrome, there has been no significant progress in curative pharmacotherapy of this disease. It is thought that the ability to target the fibrillar aggregates associated with exfoliation may offer a new therapeutic approach, facilitating their direct removal from affected tissues. Phage display techniques yielded two peptides (LPSYNLHPHVPP, IPLLNPGSMQLS) that could differentiate between exfoliative and non-affected regions of the human lens capsule. These peptides were conjugated to magnetic particles using click chemistry to investigate their ability in targeting and removing exfoliation materials from the anterior human lens capsule. The behavior of the fibrillar materials upon binding to these magnetic particles was assessed using magnetic pins and rotating magnetic fields of various strengths. Ex vivo studies showed that the magnetic particle-peptide conjugates could generate enough mechanical force to remove large aggregates of exfoliation materials from the lens capsule when exposed to a low-frequency rotating magnetic field (5000 G, 20 Hz). Biocompatibility of targeting peptides with and without conjugated magnetic particles was confirmed using MTT cell toxicity assay, live/dead cell viability assay, and DNA fragmentation studies on primary cultured human trabecular meshwork cells. This is a novel, minimally invasive, therapeutic approach for the treatment of exfoliation glaucoma via the targeting and removal of exfoliation materials that could be applied to all tissues within the anterior segment of the eye.
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Affiliation(s)
- Mehdi Ghaffari Sharaf
- Department of Chemical and Materials Engineering, University of Alberta, Edmonton, AB, Canada
| | - Kosala D Waduthanthri
- Department of Chemical and Materials Engineering, University of Alberta, Edmonton, AB, Canada
| | - Andrew Crichton
- Department of Ophthalmology, University of Calgary, Calgary, Canada
| | - Karim F Damji
- Department of Ophthalmology and Visual Sciences, University of Alberta, Edmonton, AB, Canada
| | - Larry D Unsworth
- Department of Chemical and Materials Engineering, University of Alberta, Edmonton, AB, Canada.
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Bell KC, Ozaki M, Mori K, Mizoguchi T, Nakano S, Porporato N, Ikeda Y, Chihara E, Inoue K, Manabe S, Hayashi K, Higashide T, Ideta R, Tokumo K, Kiuchi Y, Nakano M, Ueno M, Kinoshita S, Tashiro K, Sotozono C, Inatani M, Sugiyama K, Kubota T, Li Z, Wang Z, Khor CC, Aung T. Association of the CYP39A1 G204E genetic variant with increased risk of glaucoma and blindness in patients with exfoliation syndrome. Ophthalmology 2021; 129:406-413. [PMID: 34763023 DOI: 10.1016/j.ophtha.2021.11.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 08/30/2021] [Revised: 10/28/2021] [Accepted: 11/01/2021] [Indexed: 12/01/2022] Open
Abstract
PURPOSE Carriers of functionally deficient mutations in the CYP39A1 gene have been recently reported to have a 2-fold increased risk of exfoliation syndrome (XFS). The aim of this study was to evaluate the risk of blindness and related clinical phenotypes of XFS patients carrying the loss-of-function CYP39A1 G204E mutation in comparison to XFS patients without any CYP39A1 mutation. DESIGN Retrospective case study PARTICIPANTS: 35 patients diagnosed with XFS carrying the CYP39A1 G204E mutation and 150 XFS patients without any CYP39A1 mutation, who were randomly selected from the Japanese XFS cohort. METHODS Two-sided Fisher's Exact Test with an α-level <0.05 was used to estimate the significance of the calculated Odds Ratio (OR) for all categorical measures. Comparisons between groups of subjects were performed using linear mixed effect models with group as random effect and taking possible dependence between eyes within a subject into account. MAIN OUTCOME MEASURES Primary analysis compared the incidence of blindness (defined as visual acuity [VA]<0.05 decimal), prevalence of exfoliation glaucoma (XFG), history of glaucoma surgery, and indices of glaucoma severity such as visual field mean deviation (MD), intraocular pressure (IOP) and vertical cup-disc ratio (CDR), between CYP39A1 G204E carriers and those without any CYP39A1 mutation. RESULTS The overall risk for blindness was significantly higher in XFS patients carrying the CYP39A1 G204E variant (10/35 [28.6%]) compared to XFS patients without any CYP39A1 mutations (8/150 [5.3%]; OR7.1 [95%CI:2.7-20.2]; p<0.001). A higher proportion of XFS patients with the CYP39A1 G204E mutation (23/35 [65.7%]) had evidence of XFG in at least one eye compared to the comparison group (41/150 [27.3%]; OR5.1 [95%CI:2.4-11.4]; p<0.0001). Significantly higher peak IOP, larger vertical CDR and worse visual field MD were also found in CYP39A1 G204E variant carriers (p<0.001). Additionally, patients with the CYP39A1 G204E mutation (18/35 [51.4%]) required more laser or glaucoma surgical interventions compared to those without any CYP39A1 mutation (32/150 [21.3%], p<0.001). CONCLUSIONS Patients with XFS carrying the CYP39A1 G204E mutation had significantly increased risk of blindness, higher occurrence of XFG and more severe glaucoma compared to patients with XFS without any CYP39A1 mutation.
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Affiliation(s)
- Katharina C Bell
- Singapore Eye Research Institute and Singapore National Eye Center, Singapore; Duke-NUS Medical School, Singapore
| | - Mineo Ozaki
- Ozaki Eye Hospital, Hyuga, Miyazaki, Japan; Department of Ophthalmology, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Kazuhiko Mori
- Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | | | - Satoko Nakano
- Department of Ophthalmology, Oita University Faculty of Medicine, Yufu-City, Oita, Japan
| | - Natalia Porporato
- Singapore Eye Research Institute and Singapore National Eye Center, Singapore; Duke-NUS Medical School, Singapore
| | - Yoko Ikeda
- Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | | | | | | | | | - Tomomi Higashide
- Department of Ophthalmology Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
| | | | - Kana Tokumo
- Hiroshima University Department of Ophthalmology and Visual Sciences, Hiroshima, Japan
| | - Yoshiaki Kiuchi
- Hiroshima University Department of Ophthalmology and Visual Sciences, Hiroshima, Japan
| | - Masakazu Nakano
- Department of Genomic Medical Sciences, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Morio Ueno
- Department of Ophthalmology, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Shigeru Kinoshita
- Department of Frontier Medical Science and Technology for Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Kei Tashiro
- Department of Genomic Medical Sciences, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Chie Sotozono
- Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Masaru Inatani
- Department of Ophthalmology, Faculty of Medical Science, University of Fukui, Fukui, Japan
| | | | - Toshiaki Kubota
- Department of Ophthalmology, Oita University Faculty of Medicine, Yufu-City, Oita, Japan
| | - Zheng Li
- Genome Institute of Singapore, Singapore
| | - Zhenxun Wang
- Singapore Eye Research Institute and Singapore National Eye Center, Singapore; Genome Institute of Singapore, Singapore
| | - Chiea Chuen Khor
- Singapore Eye Research Institute and Singapore National Eye Center, Singapore; Genome Institute of Singapore, Singapore
| | - Tin Aung
- Singapore Eye Research Institute and Singapore National Eye Center, Singapore; Duke-NUS Medical School, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
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Aziz BF, Elawamry AI, Roshdy MM, Tawfik CA. Exfoliation Syndrome in Egypt: Prevalence and Association with Cataract in a Large Cohort. Ophthalmol Ther 2021; 10:1045-1056. [PMID: 34580841 PMCID: PMC8589887 DOI: 10.1007/s40123-021-00397-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 07/27/2021] [Accepted: 09/07/2021] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Exfoliation syndrome is an age-related disease leading to ocular and systemic complications. We aimed to evaluate the prevalence of exfoliation syndrome (XFS) in Egypt and its association with cataract as one of its comorbidities. METHODS In a retrospective, hospital-based study, 155,032 Egyptians aged over 40 years from all 27 Egyptian governorates were evaluated for the prevalence of XFS and cataract in the period between January 2015 and June 2020. RESULTS A total of 2448 (1.6%) of the studied subjects had XFS. Their mean age was 71.2 ± 9.62 years which was significantly higher than those of subjects with no XFS. Men comprised 1348 (55.1%) of those diagnosed with XFS and this association was statistically significant (OR 1.57, 95% CI 1.45-1.70). Considering the ratio between subjects in our cohort from each region and its real population, the overall corrected prevalence in Egypt was 4.49% (Territorial regions 6.89%, Upper Egypt 5.51%, Lower Egypt 4.38%, and Greater Cairo 3.29%). Among all subjects with XFS, cataract was found in 2150 subjects (87.8%) and XFS represented 6.4% of all subjects diagnosed with cataract in our cohort (n = 33,610). Among subjects with no cataract (n = 121,422), 298 subjects had XFS (OR 0.04, 95% CI 0.03-0.04). CONCLUSION Egypt has a moderate XFS prevalence compared to other countries. There is a strong association between XFS and cataract, and XFS was more common in elderly males. The results can be explained by differences in diet, ethnicity, climate, and maybe other factors.
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Affiliation(s)
- Bassem Fayez Aziz
- Faculty of Medicine, Ain Shams University, Cairo, Egypt.
- Watany Eye Hospital, Cairo, Egypt.
- Bassem Fayez Clinic, 50 Al Khalifa Al Mamoun St., Roxy, Heliopolis, Cairo, Egypt.
| | - Amr Ismail Elawamry
- Faculty of Medicine, Ain Shams University, Cairo, Egypt
- Watany Eye Hospital, Cairo, Egypt
| | - Maged Maher Roshdy
- Faculty of Medicine, Ain Shams University, Cairo, Egypt
- Watany Eye Hospital, Cairo, Egypt
| | - Caroline Atef Tawfik
- Faculty of Medicine, Ain Shams University, Cairo, Egypt
- Watany Eye Hospital, Cairo, Egypt
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Hondur G, Ucgul Atilgan C, Hondur AM. Sectorwise analysis of peripapillary vessel density and retinal nerve fiber layer thickness in exfoliation syndrome. Int Ophthalmol 2021; 41:3805-3813. [PMID: 34272630 DOI: 10.1007/s10792-021-01950-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 01/06/2021] [Accepted: 07/09/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE This cross-sectional study compared the peripapillary vessel density and retinal nerve fiber layer (RNFL) thickness in patients with exfoliation syndrome (XFS) and healthy controls for evaluation of the early structural and vascular alterations in XFS. METHODS One eye was included from 75 patients with XFS and 54 healthy controls. The patients with XFS were matched the controls for age, intraocular pressure and axial length. The vascular density of the radial peripapillary capillaries (RPCs) and the peripapillary RNFL thickness were evaluated with optical coherence tomography angiography. RESULTS The mean peripapillary RNFL thicknesses of the groups were similar in all sectors (p > 0.05 for all). However, eyes with XFS demonstrated lower mean peripapillary vessel densities in all areas (p < 0.05 for all) except for the nasal sector (p = 0.68) compared to the controls. The gradual age correlated decline in the peripapillary RNFL thickness and the RPC vessel density observed in the healthy eyes was absent in XFS (r = - 0.14 p = 0.65 and r = - 0.23 p = 0.05). CONCLUSIONS Alterations in the peripapillary vascular density despite a preserved RNFL thickness in XFS supports the hypothesis that vascular alterations may precede structural alterations and have an important role in the pathogenesis of XFS. XFS may have different effects on the microvasculature of different peripapillary areas, with the nasal sector being mostly preserved.
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Affiliation(s)
- Gozde Hondur
- Department of Ophthalmology, Ulucanlar Ophthalmology Training and Research Hospital, Altindag, 06230, Ankara, Turkey.
| | - Cemile Ucgul Atilgan
- Department of Ophthalmology, Ulucanlar Ophthalmology Training and Research Hospital, Altindag, 06230, Ankara, Turkey
| | - Ahmet M Hondur
- Department of Ophthalmology, Gazi University School of Medicine, Ankara, Turkey
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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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9
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Kemer Atik B, Kirmaci Kabakci A, Garip R. Comparison of macular thickness change by optical coherence tomography after uncomplicated cataract surgery in eyes with and without exfoliation syndrome. Int Ophthalmol 2020; 41:519-526. [PMID: 33057867 DOI: 10.1007/s10792-020-01602-2] [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: 04/27/2020] [Accepted: 10/01/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE To evaluate the effect of exfoliation syndrome (ES) on macular thickness after uncomplicated cataract surgery. METHODS 87 patients (87 eyes) who underwent uncomplicated cataract surgery were included in the study. Optical coherence tomography (OCT) films were taken in addition to the routine ophthalmologic examination before the surgery and at postoperative 1st week, 1st, 3rd and 6th months. Mean macular thickness, central macular thickness and macular volume values obtained from the 6 × 6 mm macular map in the OCT measurements were recorded. The cases were divided into two groups as Group 1: cases without ES and Group 2: cases with ES. The macular values obtained from the OCT measurements of the two groups were compared with statistical methods. RESULTS Eighty-seven eyes were included in the study; while 51 had no ES (Group 1), 36 had ES (Group 2). The mean age of all cases was 66.70 ± 9.13 years. While the mean macular thickness, central macular thickness and macular volume were similar at the preoperative visit and the postoperative 1st week of all cases (each p value > 0.05); these values were higher at the postoperative 1st, 3rd and 6th month compared to the preoperative and the postoperative 1st week values (each p value < 0.05). The highest values were obtained at the postoperative 1st month; while the values of 1st, 3rd and 6th months were statistically similar (each p value > 0.05). No statistically significant difference was observed between Group 1 and Group 2 in terms of macular volume, central macular thickness and average macular thickness in these periods. CONCLUSION Exfoliation syndrome has not been evaluated as a risk factor for an increase in macular thickness after uncomplicated cataract surgery.
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Affiliation(s)
- Burcu Kemer Atik
- University of Health Sciences Gaziosmanpasa Training and Research Hospital, İstanbul, Turkey.
| | - Asli Kirmaci Kabakci
- University of Health Sciences Okmeydani Training and Research Hospital, İstanbul, Turkey
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10
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Topcu H, Altan C, Cakmak S, Alagoz N, Pasaoglu IB, Solmaz B, Basarir B, Yasar T. Comparison of the lamina cribrosa parameters in eyes with exfoliation syndrome, exfoliation glaucoma and healthy subjects. Photodiagnosis Photodyn Ther 2020; 31:101832. [PMID: 32454088 DOI: 10.1016/j.pdpdt.2020.101832] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 03/25/2020] [Revised: 05/12/2020] [Accepted: 05/18/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE This study aimed to compare lamina cribrosa (LC) parameters obtained by spectral-domain optical coherence tomography (SD-OCT) of eyes with exfoliation syndrome (PXS), exfoliation glaucoma (PXG) and healthy subjects. METHODS In this cross-sectional comparative study, 206 eyes of 206 subjects were included. The Bruch's membrane opening distance (BMOd), the anterior and posterior borders of the LC (LC thickness) and the anterior laminar depth (ALD) were imaged using the enhanced depth imaging (EDI) mode of SD-OCT. RESULTS There were 96 eyes in the PXG group, 55 eyes in the PXS group, and 55 eyes in the control group. The LC thickness was the thinnest in the PXG group (151.10 ± 51.18 μm), followed in the PXS group (158.76 ± 49.62 μm), and the thickest in the control group (181.00 ± 39.10 μm) (p = 0.002). In PXG cases where LC was observed in the deepest location, the ALD value was highest (423.92 ± 111.75 μm) in the PXG group, followed by the control group (403.08 ± 63.56 μm), and PXS group (357.43 ± 80.87 μm) (p < 0.001). The BMOd values were largest in the PXG group (1542.43 ± 152.99 μm), followed by the control group (1506.52 ± 169.09 μm) and PXS group (1435.74 ± 141.06 μm) (p < 0.001). In the PXG group, peripapillary retinal nerve fiber layer (pRNFL) thickness, BCVA, and cup to disc (C/D) ratio were also statistically different from the other groups (p < 0.001). CONCLUSION We found thinner LC thickness in PXG and PXS cases relative to the control group. Although its severity is associated with the diagnosis and severity of glaucoma, LC thinning can be encountered as an isolated condition in the presence of exfoliation.
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Affiliation(s)
- Husna Topcu
- University of Health Sciences, Beyoglu Eye Training and Research Hospital, Istanbul, Turkey.
| | - Cigdem Altan
- University of Health Sciences, Beyoglu Eye Training and Research Hospital, Istanbul, Turkey.
| | - Semih Cakmak
- University of Health Sciences, Beyoglu Eye Training and Research Hospital, Istanbul, Turkey.
| | - Nese Alagoz
- University of Health Sciences, Beyoglu Eye Training and Research Hospital, Istanbul, Turkey.
| | - Isil Basgil Pasaoglu
- University of Health Sciences, Beyoglu Eye Training and Research Hospital, Istanbul, Turkey.
| | - Banu Solmaz
- University of Health Sciences, Beyoglu Eye Training and Research Hospital, Istanbul, Turkey.
| | - Berna Basarir
- University of Health Sciences, Beyoglu Eye Training and Research Hospital, Istanbul, Turkey.
| | - Tekin Yasar
- University of Health Sciences, Beyoglu Eye Training and Research Hospital, Istanbul, Turkey.
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11
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Sorkou KN, Manthou ME, Meditskou S, Tsinopoulos IT, Ziakas N, Kouzi-Koliakou K. Lens Epithelial Surface Disorders in Exfoliation Syndrome: A Scanning and Transmission Electron Microscopy Study. Ophthalmic Res 2020; 64:216-223. [PMID: 32403107 DOI: 10.1159/000508631] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 03/18/2020] [Accepted: 05/12/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Hydrodissection was recently reported to occur more easily in patients with exfoliation syndrome (XFS). Transmission electron microscopy (TEM) studies have already revealed alterations of the lens epithelial cells (LECs) and their apical membrane towards the lens fibers. OBJECTIVE The aim of this work was to examine the three-dimensional appearance of the lens epithelium in patients with XFS. METHODS Fourteen patients with senile cataract, 7 of whom had XFS, were included. Anterior lens capsules (aLCs) were obtained with continuous curvilinear capsulorrhexis (CCC) during phacoemulsification and were examined with scanning electron microscopy (SEM) and TEM. RESULTS Exfoliation samples exhibited an overall more irregular apical surface of the lens epithelium compared to control aLCs. The height of LECs varied extensively. On the apical surface of LECs, amorphous, crystalline-like, or microgranular extracellular material and membranous, oval-shaped structures were documented with SEM. All findings were connected to corresponding observations with TEM and were not correlated to the type of cataract. CONCLUSIONS In XFS patients, the lens epithelial surface exhibited a highly irregular margin, with extracellular material covering the apical membrane of LECs. We suggest that XFS probably causes both epithelial and lens fiber degeneration which, during CCC and mechanical extraction of the aLC from the lens cortex, result in diverse alterations.
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Affiliation(s)
- Konstantina N Sorkou
- Laboratory of Histology and Embryology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece, .,2nd Department of Ophthalmology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece,
| | - Maria Eleni Manthou
- Laboratory of Histology and Embryology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Soultana Meditskou
- Laboratory of Histology and Embryology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Ioannis T Tsinopoulos
- 2nd Department of Ophthalmology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Nikolaos Ziakas
- 2nd Department of Ophthalmology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Kokkona Kouzi-Koliakou
- Laboratory of Histology and Embryology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
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12
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Sorkou KN, Tsinopoulos IT, Tsaousis KT, Karamitsos A, Meditskou S, Ziakas N, Manthou ME. Ease of Hydrodissection during Phacoemulsification: A Comparison between Patients with and Those without Exfoliation Syndrome. Ophthalmic Res 2020; 63:497-500. [PMID: 32163946 DOI: 10.1159/000507121] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 03/08/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Exfoliation syndrome (XFS), which is associated with increased surgical complications during phacoemulsification, has a relatively high incidence in Greece. Multiannual surgical experience in XFS patients has led to the clinical observation that hydrodissection occurs more easily in XFS patients. OBJECTIVE To compare the ease of hydrodissection between cataract patients with and those without XFS. METHODS One hundred and fifteen patients with senile cataract were included in the study. Forty-two of them had XFS. All patients underwent uneventful phacoemulsification by the same surgeon. For hydrodissection, three 1-mL insulin syringes were filled with 0.5 mL balanced salt solution (BSS). Sequentially, each one was quickly and continuously injected underneath the 3, 6, and 9 o'clock positions of the anterior lens capsule. If lens mobilization was achieved with this procedure, hydrodissection was characterized as "easy." RESULTS The two groups were matched for age, gender, the biomicroscopic type of cataract, and the presence of diabetes mellitus. Glaucoma occurred more often among the XFS patients (p = 0.002). In 39 of the 42 exfoliation patients (92.8%), "easy" hydrodissection was recorded. In the control group, the corresponding number was 47 out of 73 (64.3%). The two groups differed significantly (p = 0.001). CONCLUSIONS Hydrodissection was more easily performed on the XFS patients than on the controls. This finding could be related to the extensive ultrastructural subepithelial alterations of the anterior lens capsule in XFS, as recently described in electron microscopy studies. We suggest that less BSS can be used for hydrodissection in XFS patients during phacoemulsification.
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Affiliation(s)
- Konstantina N Sorkou
- 2nd Department of Ophthalmology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece, .,Laboratory of Histology and Embryology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece,
| | - Ioannis T Tsinopoulos
- 2nd Department of Ophthalmology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Konstantinos T Tsaousis
- 2nd Department of Ophthalmology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Athanasios Karamitsos
- 2nd Department of Ophthalmology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Soultana Meditskou
- Laboratory of Histology and Embryology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Nikolaos Ziakas
- 2nd Department of Ophthalmology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Maria Eleni Manthou
- Laboratory of Histology and Embryology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
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13
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Umeno A, Tanito M, Kaidzu S, Takai Y, Yoshida Y. Involvement of free radical-mediated oxidation in the pathogenesis of pseudo exfoliation syndrome detected based on specific hydroxylinoleate isomers. Free Radic Biol Med 2020; 147:61-68. [PMID: 31852620 DOI: 10.1016/j.freeradbiomed.2019.12.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 11/28/2019] [Accepted: 12/12/2019] [Indexed: 01/19/2023]
Abstract
We reported previously that enzymatic and singlet oxygen-mediated fatty acid oxidation may be major oxidation pathways in subjects with primary open angle glaucoma, based on measurement of serum levels of hydroxylinoleate (HODE) and hydroxyarachidonate (HETE) isomers after reduction and saponification. In this study, we measured serum levels of HODE and HETE isomers to investigate the pathogenesis of exfoliation syndrome (EX). In total, 311 Japanese subjects comprising EX patients (n = 192) and non-glaucomatous control subjects (n = 119) were included in this study. Patients with EX (n = 192) were divided into EX with glaucoma (EXG) and EX without glaucoma (EXS) groups (n = 128 and n = 64, respectively) depending on the intraocular pressure. Total HODE (/linoleic acid) serum levels were significantly (p = 0.0426) higher in the EX group (202.7 ± 153.2 μmol/mol) than in the controls (167.1 ± 105.3 μmol/mol). Among the HODE isomers, the levels of 9-(E,E)-HODEs (p < 0.0001) and 13-(E,E)-HODEs (p < 0.0001), both free radical-mediated oxidation products, were higher in the EX and EXG groups than in the controls, whereas no significant difference was observed between EXS and controls. After adjusting for differences in demographic parameters, multivariate analyses confirmed the association between 9- and 13-(E,E)-HODEs and EX. This is the first report of a dramatic increase in free radical-mediated oxidation products related to the pathogenesis of EX, and our findings suggest that free radical-mediated oxidation can be one of the causes of deterioration in EX.
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Affiliation(s)
- Aya Umeno
- Health Research Institute, National Institute of Advanced Industrial Science and Technology, 2217-14 Hayashicho, Takamatsu, Kagawa, 761-0395, Japan; Department of Ophthalmology, Shimane University Faculty of Medicine, 89-1 Enya, Izumo, Shimane, 693-8501, Japan
| | - Masaki Tanito
- Health Research Institute, National Institute of Advanced Industrial Science and Technology, 2217-14 Hayashicho, Takamatsu, Kagawa, 761-0395, Japan; Department of Ophthalmology, Shimane University Faculty of Medicine, 89-1 Enya, Izumo, Shimane, 693-8501, Japan.
| | - Sachiko Kaidzu
- Department of Ophthalmology, Shimane University Faculty of Medicine, 89-1 Enya, Izumo, Shimane, 693-8501, Japan
| | - Yasuyuki Takai
- Department of Ophthalmology, Shimane University Faculty of Medicine, 89-1 Enya, Izumo, Shimane, 693-8501, Japan
| | - Yasukazu Yoshida
- Health Research Institute, National Institute of Advanced Industrial Science and Technology, 2217-14 Hayashicho, Takamatsu, Kagawa, 761-0395, Japan
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14
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Can Demirdöğen B, Koçan Akçin C, Özge G, Mumcuoğlu T. Evaluation of tear and aqueous humor level, and genetic variants of connective tissue growth factor as biomarkers for early detection of pseudo exfoliation syndrome/glaucoma. Exp Eye Res 2019; 189:107837. [PMID: 31626800 DOI: 10.1016/j.exer.2019.107837] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 10/10/2019] [Accepted: 10/10/2019] [Indexed: 12/13/2022]
Abstract
Pseudoexfoliation syndrome (PEX) may lead to the development of pseudoexfoliative glaucoma (PEG), a potential cause of irreversible blindness, if left untreated. This type of glaucoma often presents with much higher intraocular pressure (IOP) values than observed in primary open angle glaucoma, and patients are often unaware of their condition. Therefore, early diagnosis is of utmost importance in PEX and PEG. Unfortunately, no valid objective biomarkers are available that can be used for this purpose. The excessive synthesis and deposition of elastic microfibrillar pseudoexfoliation material is observed in the pathophysiology of PEX, therefore, growth factors may play roles in this pathology. Thus, in this study, we sought to determine the roles of phenotypes and genotypes of connective tissue growth factor (CTGF) as objective biomarkers for early diagnosis of PEX and PEG. Thus, we investigated possible associations involving tear and aqueous humor CTGF concentrations and four single nucleotide polymorphisms (SNPs) of the CTGF gene in PEX and PEG. The study was designed as a 2-year case-control study in the Turkish population. Study population was composed of 214 patients with PEG, 214 patients with PEX, and 214 age-matched controls for CTGF SNP analysis. Tear fluid study group consisted of 78 patients with PEG, 77 patients with PEX, and 78 controls. Aqueous humor analysis included 8 patients with PEG, 17 patients with PEX, and 23 controls. Tear fluid was collected using Schirmer strips, and aqueous humor samples were taken during cataract surgery. CTGF concentration was determined by ELISA, and total protein concentration was determined by Bradford assay in tear and aqueous humor samples. PCR followed by restriction fragment length polymorphism analysis was used for genotyping of rs6918698 G/C and rs9399005 C/T, while real-time PCR was used for rs9402373 C/G and rs12526196 T/C. Intraocular pressure, visual field score, mean deviation, and pattern standard deviation parameters were also evaluated. CTGF concentration in tear fluid was significantly higher in PEG patients compared with controls (P = 0.001), while it was lower in PEX patients. Similarly, total protein concentration in tear fluid was significantly increased in PEG patients relative to PEX patients (P = 0.026) and controls (P = 0.004). CTGF concentration in aqueous humor did not differ markedly between the groups, whereas total protein was significantly higher in the PEG group compared with the PEX group (P = 0.012) and controls (P = 0.003). Receiver operating characteristic analysis revealed that total protein in aqueous humor was a robust classifier for evaluating the presence of PEG against controls (Area under the curve = 0.897, P = 0.001). The genotypes of the studied SNPs were not significantly correlated with CTGF concentration in aqueous humor or tear fluid, and did not exhibit significant association with PEG or PEX. In conclusion, this was the first study to investigate tear fluid CTGF concentration in PEX and PEG, which came out not to be a good classifier for PEG or PEX. Total protein level in tear fluid and CTGF SNPs also did not predict PEG or PEX status successfully.
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15
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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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16
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Maric VD, Bozic MM, Cirkovic AM, Stankovic SD, Marjanovic IS, Grgurevic AD. Serum heparan sulfate and chondroitin sulfate concentrations in patients with newly diagnosed exfoliative glaucoma. PeerJ 2019; 7:e6920. [PMID: 31198625 PMCID: PMC6535222 DOI: 10.7717/peerj.6920] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 11/11/2018] [Accepted: 04/08/2019] [Indexed: 12/03/2022] Open
Abstract
Background Exfoliative glaucoma (XFG) is typically classified as a high-pressure type of secondary open-angle glaucoma that develops as a consequence of exfoliation syndrome (XFS). Exfoliation syndrome is an age-related, generalized disorder of the extracellular matrix characterized by production and progressive accumulation of a fibrillar exfoliation material (XFM) in intra- and extraocular tissues. Exfoliation material represents complex glycoprotein/proteoglycan structure composed of a protein core surrounded by glycosaminoglycans such as heparan sulfate (HS) and chondroitin sulfate (CS). The purpose of the present study was to investigate HS and CS concentrations in serum samples of patients with newly diagnosed XFG and compare the obtained values with those pertaining to newly diagnosed primary open-angle glaucoma (POAG), normal controls (NC) and subjects with XFS. Methods This case–control study involved 165 subjects, including patients with newly diagnosed XFG, patients with newly diagnosed POAG, subjects with XFS and age- and sex-matched NC. The study was conducted at the Glaucoma Department of Clinic for Eye Diseases, Clinical Centre of Serbia, as the referral center for glaucoma in Serbia. Results The mean age in the XFG, POAG, XFS and NC groups was 73.3 ± 9.0, 66.3 ± 7.8, 75.5 ± 7.0 and 73.5 ± 9.5 years, respectively, XFG vs. POAG, p < 0.001. Mean serum HS concentrations in the XFG, POAG, NC and XFS groups were 3,189.0 ± 1,473.8 ng/mL, 2,091.5 ± 940.9 ng/mL, 2,543.1 ± 1,397.3 ng/mL and 2,658.2 ± 1,426.8 ng/mL respectively, XFG vs. POAG, p = 0.001 and XFG vs. NC, p = 0.032. Mean serum CS concentrations in the XFG, POAG, NC and XFS group were 43.9 ± 20.7 ng/mL, 38.5 ± 22.0 ng/mL, 35.8 ± 16.4 ng/mL and 43.3 ± 21.8 ng/mL, respectively, XFG vs. NC, p = 0.041. Conclusions Our findings revealed greater HS and CS concentrations in XFG patients and XFS subjects compared to those without XFM. Implications of HS and CS in the pathophysiology of XFS and glaucoma should be studied further. Serum is easily accessible and should thus be explored as rich sources of potential biomarkers. Further research should aim to identify XFG biomarkers that could be utilized in routine blood analysis tests, aiding in timely disease diagnosis.
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Affiliation(s)
- Vesna D Maric
- Clinic for Eye Diseases, Clinical Center of Serbia, Belgrade, Serbia.,Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Marija M Bozic
- Clinic for Eye Diseases, Clinical Center of Serbia, Belgrade, Serbia.,Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Andja M Cirkovic
- Department for Medical Statistics and Informatics, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Sanja Dj Stankovic
- Center for Medical Biochemistry, Clinical Center of Serbia, Belgrade, Serbia
| | - Ivan S Marjanovic
- Clinic for Eye Diseases, Clinical Center of Serbia, Belgrade, Serbia.,Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Anita D Grgurevic
- Institute of Epidemiology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
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17
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Sorkou KN, Manthou ME, Meditskou S, Ziakas N, Tsinopoulos IT. Exfoliation Fibrils within the Basement Membrane of Anterior Lens Capsule: A Transmission Electron Microscopy Study. Curr Eye Res 2019; 44:882-886. [PMID: 30986086 DOI: 10.1080/02713683.2019.1608262] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 10/27/2022]
Abstract
Purpose: The aim of the present study was to demonstrate novel findings recognized within the basement membrane of the anterior lens capsules (ALCs) in exfoliation syndrome, in a transmission electron microscopy (TEM) study. Materials and methods: Twenty-one patients with age-related cataract were included in the study. Eleven out of them suffered from exfoliation syndrome (XFS). Anterior lens capsules were obtained from patients during phacoemulsification, applying continuous curvilinear capsulorhexis and then were examined by transmission electron microscope. Results: Six out of 11 examined basement membranes with XFS had a granular appearance with dotted deposits of electron-dense material. Fibrils were clearly detected, longitudinally, within the basement membrane, usually located in the outer quarter of the basement membrane, towards the anterior chamber. Conclusion: New data about the exfoliation material and its location within the basement membrane of the anterior lens capsules of XFS patients are presented. These findings constitute new evidence for XFS's histopathogenesis and might help clarify the lenticular exfoliation material's (XFM) mechanisms of origin.
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Affiliation(s)
- Konstantina N Sorkou
- a Laboratory of Histology and Embryology, Medical School, Aristotle University of Thessaloniki , Thessaloniki , Greece.,b 2nd Department of Ophthalmology, Medical School, Aristotle University of Thessaloniki , Thessaloniki , Greece
| | - Maria Eleni Manthou
- a Laboratory of Histology and Embryology, Medical School, Aristotle University of Thessaloniki , Thessaloniki , Greece
| | - Soultana Meditskou
- a Laboratory of Histology and Embryology, Medical School, Aristotle University of Thessaloniki , Thessaloniki , Greece
| | - Nikolaos Ziakas
- b 2nd Department of Ophthalmology, Medical School, Aristotle University of Thessaloniki , Thessaloniki , Greece
| | - Ioannis T Tsinopoulos
- b 2nd Department of Ophthalmology, Medical School, Aristotle University of Thessaloniki , Thessaloniki , Greece
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Janjetović Ž, Bušić M, Bosnar D, Barać J, Genda I. SPECIFIC CHARACTERISTICS OF OCULAR BIOMETRIC FACTORS IN GLAUCOMATOUS PATIENTS WITH PSEUDOEXFOLIATIVE SYNDROME AS MEASURED BY OPTICAL LOW-COHERENCE REFLECTOMETRY. Acta Clin Croat 2019; 58:87-94. [PMID: 31363329 PMCID: PMC6629193 DOI: 10.20471/acc.2019.58.01.11] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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] [Indexed: 11/30/2022] Open
Abstract
The aim of the study was to assess biometric factor aberrations and differences among groups of eyes with cataract and pseudoexfoliative syndrome, cataract and pseudoexfoliative glaucoma, and cataract and primary open-angle glaucoma (POAG), and to determine biometric factors of the eye specific for the group of glaucomatous patients with pseudoexfoliative syndrome by use of optical low-coherence reflectometry. This retrospective study included 72 patients, and the study sample of 102 eyes was divided into the following three groups according to diagnosis: 29 eyes with pseudoexfoliative syndrome and cataract; 36 eyes with POAG and cataract; and 37 eyes with pseudoexfoliative glaucoma and cataract. Data on biometric measurements (central corneal thickness, pupillary diameter, anterior chamber depth, lens thickness, axial length, retinal thickness, astigmatism and white-to-white) obtained by use of optical low-coherence reflectometry on a Lenstar LS 900® (Haag-Streit International) were collected and analyzed by thorough survey of medical documentation of patients scheduled for cataract surgery at Department of Ophthalmology, Sveti Duh University Hospital in Zagreb, Croatia. Comparative analysis of the groups yielded statistically significant differences in central corneal thickness (F2/99=7.066; p=0.001) and lens thickness (F2/96=5.133; p=0.008). The group of eyes diagnosed with pseudoexfoliative glaucoma and cataract had a significantly thinner cornea as compared with the other two groups and a significantly thicker lens as compared with the group of eyes with POAG and cataract. In conclusion, optical low-coherence reflectometry revealed differences in biometric factors among the three groups of eyes, with a statistically significantly thinner cornea and thicker lens in the group of glaucomatous patients with pseudoexfoliative syndrome.
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Affiliation(s)
| | - Mladen Bušić
- 1Department of Ophthalmology and Optometry, Dr Josip Benčević General Hospital, Slavonski Brod, Croatia; 2Department of Ophthalmology, Sveti Duh University Hospital, Zagreb, School of Medicine, Josip Juraj Strossmayer University, Osijek, Croatia; 3Department of Ophthalmology, Osijek University Hospital Center, School of Medicine, Josip Juraj Strossmayer University, Osijek, Croatia
| | - Damir Bosnar
- 1Department of Ophthalmology and Optometry, Dr Josip Benčević General Hospital, Slavonski Brod, Croatia; 2Department of Ophthalmology, Sveti Duh University Hospital, Zagreb, School of Medicine, Josip Juraj Strossmayer University, Osijek, Croatia; 3Department of Ophthalmology, Osijek University Hospital Center, School of Medicine, Josip Juraj Strossmayer University, Osijek, Croatia
| | - Josip Barać
- 1Department of Ophthalmology and Optometry, Dr Josip Benčević General Hospital, Slavonski Brod, Croatia; 2Department of Ophthalmology, Sveti Duh University Hospital, Zagreb, School of Medicine, Josip Juraj Strossmayer University, Osijek, Croatia; 3Department of Ophthalmology, Osijek University Hospital Center, School of Medicine, Josip Juraj Strossmayer University, Osijek, Croatia
| | - Ivanka Genda
- 1Department of Ophthalmology and Optometry, Dr Josip Benčević General Hospital, Slavonski Brod, Croatia; 2Department of Ophthalmology, Sveti Duh University Hospital, Zagreb, School of Medicine, Josip Juraj Strossmayer University, Osijek, Croatia; 3Department of Ophthalmology, Osijek University Hospital Center, School of Medicine, Josip Juraj Strossmayer University, Osijek, Croatia
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ALAY C, TEKELİ O, YANIK ODABAŞ Ö, ÇALIŞ KARANFİL F. Evaluation of the retinal nerve fiber layer and ganglion cell complex thicknesses in patients with exfoliation syndrome. Turk J Med Sci 2019; 49:272-278. [PMID: 30761874 PMCID: PMC7350790 DOI: 10.3906/sag-1803-27] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Background/aim This study aimed to evaluate retinal nerve fiber layer (RNFL) and ganglion cell complex (GCC) thicknesses using spectral domain optical coherence tomography (SD-OCT) in both unilateral and bilateral exfoliation syndrome (XFS) patients Materials and methods Twenty-four patients with unilateral XFS, 20 patients with bilateral XFS, and 23 healthy subjects were enrolled in this study. Eyes with XFS were compared with both fellow eyes and age-matched control subject eyes in terms of mean and segmental RNFL thickness and minimum, mean, and segmental GCC thickness. Results In the bilateral XFS group, minimum GCC of the right eye (75.80 ± 11.6 μm) was significantly thinner compared with the right eyes of the control group (81.83 ± 6.6 μm) (P < 0.05). Also, superior RNFL was thinner in the right eye (106.90 ± 16.7 μm) compared with left eye (114.15 ± 18.1 μm) in the bilateral XFS group (P < 0.05). No significant differences in the unilateral XFS group were detected in GCC and RNFL analysis. Conclusion Minimum GCC value may be the first parameter affected in the conversion of XFS to exfoliative glaucoma followed by RNFL changes.
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Affiliation(s)
- Cem ALAY
- Tavşanlı Doç. Dr. Mustafa Kalemli State Hospital, KütahyaTurkey
| | - Oya TEKELİ
- Department of Ophthalmology , Faculty of Medicine, Ankara University, AnkaraTurkey
| | - Özge YANIK ODABAŞ
- Alaaddin Keykubat University Alanya Education and Research Hospital, AntalyaTurkey
- * To whom correspondence should be addressed. E-mail:
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Sorkou KN, Manthou ME, Tsaousis KT, Brazitikos P, Tsinopoulos IT. Transmission electron microscopy study of undescribed material at the anterior lens capsule in exfoliation syndrome. Graefes Arch Clin Exp Ophthalmol 2018; 256:1631-7. [PMID: 29982898 DOI: 10.1007/s00417-018-4062-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Revised: 06/21/2018] [Accepted: 06/27/2018] [Indexed: 10/28/2022] Open
Abstract
PURPOSE In the present study, we aimed to examine the anterior lens capsule using transmission electron microscopy (TEM) and compare the findings in patients with and without exfoliation syndrome (XFS). METHODS Eighteen patients with senile cataract, including 10 with XFS, were included. Anterior capsule specimens were obtained from patients during phacoemulsification through continuous curvilinear capsulorrhexis, and were examined via TEM. RESULTS In the XFS group, in addition to the typical fibrillar material above the basement membrane of the lens capsule, another unknown, microgranular, electron-dense, unbound material was observed beneath the lens epithelium. Larger formations appeared to detach from the surface of the epithelial cells, and oval or crescent-shaped structures of an electron-denser material were less commonly observed on the apical side of the epithelium. Membranous structures were occasionally attached to epithelial cells that often exhibited thicker or ruptured cell membranes on their apical-free side, along with deposits of electron-dense material. Degenerative lesions of various severities were observed at the epithelium in both groups. CONCLUSION The anterior lens capsule epithelium in patients with XFS exhibits a highly irregular and rough margin on its free side, with unbound material over its membrane, which probably contributes to loose contact with the underlying lens and leads to different clinical behaviors in XFS eyes during cataract surgery.
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Katsanos A, Konstas AG, Mikropoulos DG, Quaranta L, Voudouragkaki IC, Athanasopoulos GP, Asproudis I, Teus MA. A Review of the Clinical Usefulness of Selective Laser Trabeculoplasty in Exfoliative Glaucoma. Adv Ther 2018; 35:619-630. [PMID: 29644538 PMCID: PMC5960484 DOI: 10.1007/s12325-018-0695-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Indexed: 11/30/2022]
Abstract
In the last decade, selective laser trabeculoplasty (SLT) has been commonly used in the management of several different types of glaucoma, as either primary or adjunct therapy. The technique has an excellent safety profile and is at least as effective as argon laser trabeculoplasty. Although the actual mechanism of action of SLT remains unclear, evidence has shown that it does not induce morphologically evident trabecular meshwork alterations. SLT's non-disruptive mode of action offers the advantage of repeatability. Exfoliation glaucoma (XFG) is a secondary open-angle glaucoma with unfavorable intraocular pressure (IOP) characteristics, which typically carries a poorer long-term prognosis than primary open-angle glaucoma. Consequently, patients with XFG often need multiple medications to achieve IOP levels that prevent disease progression. Because complicated pharmacotherapy regimens undermine the long-term tolerability and compliance of patients with XFG, options such as SLT may decrease the burden of multiple therapies and ultimately improve prognosis. In fact, SLT may be a particularly attractive option in XFG because the pigment-laden trabecular tissue of these patients enhances the absorption of laser energy and thus augments the biologic effects induced by this treatment. The current article reviews the postulated mechanisms of action of SLT, discusses practical aspects of SLT therapy, and examines selected peer-reviewed literature pertaining to the clinical usefulness of this modality in XFG patients.
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Affiliation(s)
- Andreas Katsanos
- Department of Ophthalmology, University of Ioannina, Ioannina, Greece
| | - Anastasios G Konstas
- 1st University Department of Ophthalmology, Aristotle University of Thessaloniki, Thessaloniki, Greece.
- 3rd University Department of Ophthalmology, Aristotle University of Thessaloniki, Thessaloniki, Greece.
| | - Dimitrios G Mikropoulos
- 3rd University Department of Ophthalmology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Irini C Voudouragkaki
- 1st University Department of Ophthalmology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Georgios P Athanasopoulos
- 1st University Department of Ophthalmology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Ioannis Asproudis
- Department of Ophthalmology, University of Ioannina, Ioannina, Greece
| | - Miguel A Teus
- Department of Ophthalmology, Hospital Universitario "Principe de Asturias," Universidad de Alcalá, Alcalá de Henares, Spain
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Tijani M, Albaroudi N, Boutimzine N, Cherkaoui O, Laghmari M. [Prevalence of exfoliation syndrome and cardiovascular diseases in patients scheduled for cataract surgery]. J Fr Ophtalmol 2017; 40:623-628. [PMID: 28865939 DOI: 10.1016/j.jfo.2017.02.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 11/29/2016] [Revised: 02/02/2017] [Accepted: 02/08/2017] [Indexed: 02/07/2023]
Abstract
PURPOSE To study the prevalence of exfoliation syndrome (XFS) and its association with cardiovascular disease in patients scheduled for cataract surgery. MATERIAL AND METHODS This is a retrospective, single center, descriptive study of 260 patients admitted to a tertiary teaching hospital in Rabat, Morocco, between January 2015 and March 2016 and scheduled for cataract surgery. All patients had a preoperative cardiovascular exam, an electrocardiogram and, if needed, echocardiography. Statistical analysis was performed using SPSS software. Results with a P-value<0.05 were considered statistically significant. RESULTS This study included 246 patients: 146 women (59.3 %) and 100 men (40.7 %). The mean age (years) was 67.6±10.1. The percentage of XFS increased with age (P=0.02). Sixty-two percent of patients with cardiovascular disease also had exfoliation syndrome (P<0.001). Patients with XFS had hypertension in 46.5 % of cases. 14 subjects (19.7 %) had ischemic heart disease and XFS. Using multivariate logistic regression and after adjusting for age, diabetes mellitus, hypertension, ischemic heart disease and arrhythmias, smoking was the only factor associated with exfoliation syndrome (P=0.01, odds ratio=5.2, confidence interval 95 %=1.35-20.15). CONCLUSION Exfoliation syndrome is a common condition in the aging cataract population. Ischemic heart disease and hypertension are frequently associated with XFS. Smoking could be another factor associated with this syndrome.
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Affiliation(s)
- M Tijani
- Service d'ophtalmologie-A, hôpital des spécialités, centre hospitalier universitaire, Rabat, Maroc.
| | - N Albaroudi
- Service d'ophtalmologie-A, hôpital des spécialités, centre hospitalier universitaire, Rabat, Maroc
| | - N Boutimzine
- Service d'ophtalmologie-A, hôpital des spécialités, centre hospitalier universitaire, Rabat, Maroc
| | - O Cherkaoui
- Service d'ophtalmologie-A, hôpital des spécialités, centre hospitalier universitaire, Rabat, Maroc
| | - M Laghmari
- Service d'ophtalmologie-A, hôpital des spécialités, centre hospitalier universitaire, Rabat, Maroc
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Chen L, Wang NL, Rong SS, Huang LN, Cheng HB. [Association analysis between LOXL1 gene and exfoliation syndrome]. Zhonghua Yan Ke Za Zhi 2017; 53:294-9. [PMID: 28412803 DOI: 10.3760/cma.j.issn.0412-4081.2017.04.012] [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] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To evaluate the association of LOXL gene and XFS/XFG in Chinese population. Methods: Experimental research. Fifty unrelated patients from shenzhen Eye Hospital and Beijing Tongren Hospital with exfoliation syndrome or exfoliation glaucoma and 100 control subjects were included. All the seven exons and the splicing region were amplified by polymerase chain reaction (PCR) and were directly sequenced. The comparison of allelic frequencies and genotype frequencies between case and control groups was performed using standard χ(2) test. Result: Allelic association analysis showed that there were significant differences in the allelic distributions between the two groups for two loci in the LOXL gene: int6: 25975 C>A and ex7:26145 G>A. The frequency of A allele at int6: 25975 C>A was significantly higher in cases than in controls (χ(2)=92.31, P<0.01), OR=1.66(95%CI:1.42-1.96). The frequency of genotype CA was significantly higher in cases than in controls (χ(2)=109.09, P<0.01), OR=5.00 (95%CI: 2.87-8.70). The frequency of A allele of ex7: 26145 G>A was significantly higher in cases than in controls (χ(2)=79.25, P<0.01), OR=1.54 (95%CI: 1.33-1.78). The frequency of genotype GA was significantly higher in cases than in controls(χ(2)=91.30, P<0.01), OR=3.33 (95%CI: 2.18-5.09). Haplotype AA and AG were risk and haplotype CG was protective for the disease. Conclusions: Two loci in the LOXL1 gene were found to be associated with XFS/XFG. Further study is needed to unravel the effect of LOXL1 on thedevelopment of the disease.(Chin J Ophthalmol, 2017, 53: 294-299).
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Aboobakar IF, Johnson WM, Stamer WD, Hauser MA, Allingham RR. Major review: Exfoliation syndrome; advances in disease genetics, molecular biology, and epidemiology. Exp Eye Res 2016; 154:88-103. [PMID: 27845061 DOI: 10.1016/j.exer.2016.11.011] [Citation(s) in RCA: 82] [Impact Index Per Article: 10.3] [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: 08/04/2016] [Revised: 10/06/2016] [Accepted: 11/10/2016] [Indexed: 12/20/2022]
Abstract
Exfoliation syndrome (XFS) is a common age-related disorder that leads to deposition of extracellular fibrillar material throughout the body. The most recognized disease manifestation is exfoliation glaucoma (XFG), which is a common cause of blindness worldwide. Recent developments in XFS genetics, cell biology and epidemiology have greatly improved our understanding of the etiology of this complex inherited disease. This review summarizes current knowledge of XFS pathogenesis, identifies gaps in knowledge, and discusses areas for future research.
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Affiliation(s)
- Inas F Aboobakar
- Department of Ophthalmology, Duke University Medical Center, Durham, NC, USA
| | - William M Johnson
- Department of Ophthalmology, Duke University Medical Center, Durham, NC, USA
| | - W Daniel Stamer
- Department of Ophthalmology, Duke University Medical Center, Durham, NC, USA
| | - Michael A Hauser
- Department of Ophthalmology, Duke University Medical Center, Durham, NC, USA
| | - R Rand Allingham
- Department of Ophthalmology, Duke University Medical Center, Durham, NC, USA.
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Ekiz T, Helvacı S. Bone Mineral Density and 25-Hydroxyvitamin D Levels in Patients With Ocular Pseudo exfoliation Syndrome: A Case-Control Study. J Clin Densitom 2016; 19:419-422. [PMID: 27130258 DOI: 10.1016/j.jocd.2016.03.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Revised: 03/24/2016] [Accepted: 03/28/2016] [Indexed: 01/28/2023]
Abstract
The objective of this study was to evaluate bone mineral density (BMD) and 25-hydroxyvitamin D (25(OH)D) levels in patients with ocular pseudoexfoliation (PEX) syndrome. Subjects with ocular PEX syndrome were included in the PEX group and subjects without PEX syndrome were defined as the control group. 25(OH)D levels were measured by chemiluminescence microparticle immunoassay method. BMD measurements were obtained from the femoral neck and lumbar spine by using dual-energy X-ray absorptiometry. The results were expressed as gram per square centimeter, T-scores (standard deviation compared to a healthy 30-yr-old male), and Z-scores (standard deviation compared to the subject's age). Independent t-test was used to compare the mean and medians of the groups. The PEX group consisted of 23 subjects with a mean age of 71.09 ± 2.02 yr and the control group consisted 46 subjects with a mean age of 67.04 ± 1.34 yr. There was no significant difference between the groups as regards the BMD measurements (gram per square meter), T-scores, and Z-scores. Both groups have low 25(OH)D, yet vitamin 25(OH)D levels were similar in the groups (p > 0.05). In the light of our results, although patients with ocular PEX have low BMD and 25(OH)D, BMD and 25(OH)D do not appear to be linked to ocular PEX syndrome in our study population.
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Affiliation(s)
- Timur Ekiz
- Department of Physical and Rehabilitation Medicine, Elbistan State Hospital, Kahramanmaraş, Turkey.
| | - Sezer Helvacı
- Department of Ophtalmology, Elbistan State Hospital, Kahramanmaraş, Turkey
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Salazar Méndez R, Cuesta García M, Llaneza Velasco ME, Rodríguez Villa S, Cubillas Martín M, Alonso Álvarez CM. Usefulness of surgical complexity classification index in cataract surgery process. ACTA ACUST UNITED AC 2016; 91:281-7. [PMID: 26897332 DOI: 10.1016/j.oftal.2016.01.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Revised: 12/18/2015] [Accepted: 01/04/2016] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To evaluate the usefulness of surgical complexity classification index (SCCI) to predict the degree of surgical difficulty in cataract surgery. MATERIAL AND METHODS This retrospective study includes data collected between January 2013 and December 2014 from patients who underwent cataract extraction by phacoemulsification at our hospital. A sample size of 159 patients was obtained by simple random sampling (P=.5, 10% accuracy, 95% confidence). The main variables were: recording and value of SCCI in electronic medical record (EMR), presence of exfoliation syndrome (XFS), criteria for inclusion in surgical waiting list (SWL), and functional results. SCCI was classified into 7 categories (range: 1-4) according to predictors of technical difficulty, which was indirectly estimated in terms of surgical time (ST). All statistical analyses were performed using SPSS v15.0 statistical software. RESULTS Prevalence of XFS was 18.2% (95%CI: 11.9-24.5). In terms of quality indicators in the cataract surgery process, 96.8% of patients met at least one of the criteria to be included in SWL, and 98.1% gained ≥2 Snellen lines. The SCCI was recorded in EMR of 98.1% patients, and it was grouped for study into 2 categories: High and low surgical complexity. Statistically significant differences in the distribution of ST were found depending on the assigned SCCI (P<.005) and the presence of XFS (P<.005). CONCLUSIONS The SCCI enables to estimate the degree of surgical complexity in terms of ST in cataract surgery, which is especially useful in those areas with high prevalence of XFS, because of the higher theoretical risk of surgical complications.
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Fan BJ, Pasquale LR, Kang JH, Levkovitch-Verbin H, Haines JL, Wiggs JL. Association of clusterin (CLU) variants and exfoliation syndrome: An analysis in two Caucasian studies and a meta-analysis. Exp Eye Res 2015; 139:115-22. [PMID: 26272660 DOI: 10.1016/j.exer.2015.08.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [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: 12/09/2014] [Revised: 08/04/2015] [Accepted: 08/05/2015] [Indexed: 11/18/2022]
Abstract
Exfoliation syndrome (XFS) is an important risk factor for glaucoma (XFG) worldwide. LOXL1 variants are highly associated with XFS in most populations; however, the high frequency of risk alleles in normal individuals and the reversal of risk alleles in different ethnic populations suggest that other factors contribute to XFS pathogenesis. Clusterin (CLU) is an extracellular matrix chaperone that prevents protein aggregation and is highly expressed in ocular tissues affected by XFS. Studies examining common CLU variants for association with XFS have been inconsistent. The purpose of this study was to evaluate CLU variants for association with XFS in two independent datasets from the United States (222 cases and 344 controls) and Israel (92 cases and 102 controls). Seven tag SNPs that captured >95% of alleles at r(2) greater than 0.8 across the CLU genomic region were genotyped using TaqMan assays. Genotypes for an additional SNP, rs2279590, were imputed using phased haplotypes of HapMap reference CEU samples. Of the 8 CLU SNPs selected for the study, none were significantly associated with XFS in either case-control group (age and sex adjusted P > 0.14 and 0.36, respectively, in the US and Israeli datasets), or when they were meta-analyzed together (age and sex adjusted P > 0.13). Haplotype analysis using all 8 SNPs or only the promoter region SNPs also did not show significant associations of CLU with XFS in the combined US and Israeli dataset (P > 0.28). Meta-analysis of the data from this study and previous studies in Caucasian populations (1184 cases and 978 controls) resulted in statistically significant association of rs2279590 with XFS (summary OR = 1.18, 95% CI: 1.03-1.33, P = 0.01). Significant association between rs2279590 and XFS was also found in Indian populations (summary OR = 0.76, 95% CI: 0.61-0.96; P = 0.02); however, significant heterogeneity between the Caucasian and Indian populations possibly due to reversal of the risk allele precluded an overall meta-analysis for rs2279590 (Q = 0.001, I(2) = 91%). No significant association was identified for rs3087554 in either Caucasian populations (summary OR = 0.90, 95% CI: 0.77-1.05, P = 0.17) or Indian populations (summary OR = 0.89, 95% CI: 0.72-1.10, P = 0.28), or in both populations combined (1705 cases and 3713 controls; summary OR = 0.90, 95% CI: 0.79-1.01, P = 0.08). Significant heterogeneity precluded the addition of the Japanese data to the meta-analysis for rs3087554 (Q = 0.006, I(2) = 87%). Our results suggest that common CLU variants may contribute to modest XFS risk but even larger datasets are required to confirm these findings.
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Affiliation(s)
- Bao J Fan
- Department of Ophthalmology, Harvard Medical School, Massachusetts Eye and Ear Infirmary, Boston, MA, USA
| | - Louis R Pasquale
- Department of Ophthalmology, Harvard Medical School, Massachusetts Eye and Ear Infirmary, Boston, MA, USA; Channing Division of Network Medicine, Department of Medicine, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA
| | - Jae H Kang
- Channing Division of Network Medicine, Department of Medicine, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA
| | - Hani Levkovitch-Verbin
- Goldschleger Eye Institute, Chaim Sheba Medical Center, Tel Aviv University, Tel Hashomer, Israel
| | - Jonathan L Haines
- Department of Epidemiology & Biostatistics, Case Western Reserve University, Cleveland, OH, USA
| | - Janey L Wiggs
- Department of Ophthalmology, Harvard Medical School, Massachusetts Eye and Ear Infirmary, Boston, MA, USA.
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Mocan MC, Ustunel S, Dikmetas O, Bozkurt B, Irkec M. The effect of pharmacologic pupillary dilatation on anterior segment parameters in patients with exfoliation syndrome. J Optom 2014; 7:51-56. [PMID: 24646901 PMCID: PMC3938737 DOI: 10.1016/j.optom.2013.05.001] [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] [Subscribe] [Scholar Register] [Received: 04/02/2013] [Revised: 04/30/2013] [Accepted: 04/30/2013] [Indexed: 06/03/2023]
Abstract
PURPOSE The purpose of this study was to evaluate the effect of pharmacologic pupillary dilatation on anterior chamber depth (ACD) and anterior chamber angle (ACA) in eyes with exfoliation syndrome (XFS). METHODS Thirty-six eyes of 36 patients with XFS were evaluated with slit-lamp examination, Goldmann applanation tonometry and ultrasound biomicroscopy (UBM) under standard light conditions. Primary outcome parameters were defined as the change in ACD and ACA measured before and 40 min after instillation of a single drop of either 1% cyclopentolate (Group I; n=12), 2.5% phenylephrine (Group II; n=12) or 1% tropicamide (Group III; n=12). Change in intraocular pressure (IOP) during the same time interval was included as a secondary outcome measure. RESULTS The average predilatation ACD, ACA and IOP values in the study subjects were 2.54±0.40 mm, 27.9±6.3° and 14.9±3.1 mmHg, respectively. There were no significant differences in the mean age (p=0.461), the female/male ratio (p=0.232), baseline ACD (p=0.841), ACA (p=0.761) or IOP (p=0.070) within the three groups. Differences in dilation induced changes in ACD (p=0.108), ACA (p=0.636) and IOP (p=0.160) between the three groups were not statistically significant. CONCLUSION Pupillary dilatation with a single drop of 1.0% cyclopentolate, 2.5% phenylephrine or 1% tropicamide is not associated with shallowing of the anterior chamber or narrowing of the ACA in patients with XFS who present with open angles.
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Affiliation(s)
- Mehmet Cem Mocan
- Hacettepe University School of Medicine, Department of Ophthalmology, Ankara, Turkey.
| | - Saim Ustunel
- Hacettepe University School of Medicine, Department of Ophthalmology, Ankara, Turkey
| | - Ozlem Dikmetas
- Hacettepe University School of Medicine, Department of Ophthalmology, Ankara, Turkey
| | - Banu Bozkurt
- Selcuk University Faculty of Medicine, Department of Ophthalmology, Konya, Turkey
| | - Murat Irkec
- Hacettepe University School of Medicine, Department of Ophthalmology, Ankara, Turkey.
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