AIM:To investigate the efficacy and safety of 90°inferonasal sectoral goniotomy with an micro-vitreoretinal(MVR)blade in patients with mild-to-moderate primary open-angle glaucoma(POAG)and pseudoexfoliation glauc...AIM:To investigate the efficacy and safety of 90°inferonasal sectoral goniotomy with an micro-vitreoretinal(MVR)blade in patients with mild-to-moderate primary open-angle glaucoma(POAG)and pseudoexfoliation glaucoma(PEXG).METHODS:This retrospective study included data from 60 patients(60 eyes)who underwent stand-alone goniotomy or goniotomy with phacoemulsification between August 2021 and January 2023,and 45 eyes underwent goniotomy combined with phacoemulsification,and 15 eyes underwent goniotomy as a stand-alone procedure.Postoperatively,intraocular pressure(IOP)and the number of medications were collected at 1,3,6,and 12 mo.The side effects of surgery were recorded 1 d,1 wk,and 1,3,6,and 12 mo postoperatively.The primary outcomes were a reduction in IOP of at least 20%from baseline and a decrease in the number of antiglaucomatous medications in 1 a postoperatively.The secondary outcome was surgical success,defined as an IOP<18 mmHg with(qualified)or without(complete)antiglaucomatous medication at 1 a postoperatively.RESULTS:At the end of 1 a,78%of patients achieved both a>20%reduction in IOP and a reduction in the number of medications used.Overall success was achieved in 63%of patients.Microhyphaema was the most common complication,none of the patients experienced a complication requiring surgical intervention.CONCLUSION:Sectoral inferonasal goniotomy with an MVR blade significantly reduced IOP and the number of medications required in patients with POAG and PEXG,and 1-year follow-up after goniotomy showed that the need for filtering surgery was either eliminated or delayed in a significant number of patients.展开更多
AIM:To present an overview of the research on global glaucoma treatment in the last decade in terms of publication year,journals,countries/regions,organizations,references,and keywords,to investigate the current resea...AIM:To present an overview of the research on global glaucoma treatment in the last decade in terms of publication year,journals,countries/regions,organizations,references,and keywords,to investigate the current research international trends and hot topics in this area.METHODS:Bibliometric analysis was conducted on 9128 articles in the Web of Science Core Collection(WoSCC;Clarivate)database.Quantitative and qualitative analysis was employed using VOSviewer(v1.6.18),Pajek(v1.0.0.0),and CiteSpace(v6.1.R2)software.RESULTS:The 9128 papers relating to glaucoma treatment were published from April 2013 to April 2023,of which 7482 articles(82%)were original research articles and 1464(18%)were review articles.The United States(2867)and Johns Hopkins University(166)were the most productive country and institution,respectively,but the University College London had the highest h-index(54).The Journal of Glaucoma was the most productive and Ophthalmology had the highest h-index compared with other journals.The Keywords of interest included treatment surgery,cyclophotocoagulation,minimally invasive glaucoma surgery(MIGS),trabeculectomy,baerveldt,epidemiology,medication adherence,nanoparticle,optical coherence tomography(OCT),gene therapy,and artificial intelligence(AI).Glaucoma surgery appeared as a current research hotspot through the analysis of keywords.CONCLUSION:This study provides insights into the research trends and potential research hotspots in the treatment of glaucoma.This will help researchers to evaluate research policies and to promote international cooperation.展开更多
Glaucoma is characterized by chronic progressive optic nerve damage and retinal ganglion cell death.Although extensive research has been conducted on neuroprotection for retinal ganglion cells,there is still no treatm...Glaucoma is characterized by chronic progressive optic nerve damage and retinal ganglion cell death.Although extensive research has been conducted on neuroprotection for retinal ganglion cells,there is still no treatment for clinical use.Recent evidence shows that extracellular vesicles isolated from a variety of stem cells are efficacious in retinal ganglion cell neuroprotection.In this study,we tested the novel extracellular vesicle source of the retinal progenitor R-28 cell line in vitro and in vivo.We isolated and characterized extracellular vesicles from R-28 cells and tested their therapeutic efficacy in terms of retinal ganglion cell survival in vitro and in an in vivo glaucoma model,measuring retinal ganglion cell survival and preservation of their axons.Additionally,we tested extracellular vesicles for their neuroprotective capacity in retinal ganglion cells differentiated from human embryonic stem cells.Finally,we investigated miRNA changes in retinal ganglion cells with R-28 extracellular vesicle treatment,and predicted possible pathways that may be modulated.R-28 extracellular vesicles improved retinal ganglion cell survival but failed to preserve axons significantly.Moreover,the results also illustrated the neuroprotection of R-28 extracellular vesicles on human retinal ganglion cells.Finally,we also showed changes in hsa-miRNA-4443,hsa-miRNA-216a-5p,hsa-let-7e-5p,hsa-miRNA-374b-5p,hsa-miRNA-331-3p,and hsa-miRNA-421 expressions,which may have neuroprotective potential on retinal ganglion cell degeneration.This study will pave the way for miRNA and extracellular vesicle-based neuroprotective therapies for glaucoma.展开更多
Neurodegenerative diseases account for a large and increasing health and economic burden worldwide.With an increasingly aged population,this burden is set to increase.Optic neuropathies make up a large proportion of n...Neurodegenerative diseases account for a large and increasing health and economic burden worldwide.With an increasingly aged population,this burden is set to increase.Optic neuropathies make up a large proportion of neurodegenerative diseases with glaucoma being highly prevalent.Glaucoma is characterized by the progressive dysfunction and loss of retinal ganglion cells and their axons which make up the optic nerve.It is the leading cause of irreversible vision loss and affects an estimated 80 million people.The mammalian central nervous system is non-regenerative and,once lost or injured,retinal ganglion cells cannot regenerate an axon into the optic nerve under basal conditions.Thus,strategies that provide neuroprotection to stressed,dysfunctional,or dying retinal ganglion cells are likely to be of high therapeutic and translational value.Advancing age,genetics,and elevated intraocular pressure are all major risk factors for glaucoma,however,all clinically available glaucoma treatments focus on intraocular pressure management and do not directly address the neurodegenerative component of glaucoma.展开更多
AIM:To study the relationships between amplitude of low-frequency fluctuations(ALFF)changes and clinical ophthalmic parameters in patients with primary open angle glaucoma(POAG)and analyze the diagnostic value of ALFF...AIM:To study the relationships between amplitude of low-frequency fluctuations(ALFF)changes and clinical ophthalmic parameters in patients with primary open angle glaucoma(POAG)and analyze the diagnostic value of ALFF.METHODS:Twenty-four POAG patients and 24 healthy controls(HCs)underwent resting-state functional magnetic resonance imaging(rs-fMRI).Nonparametric rank-sum tests were used to compare the ALFF values in the slow-4 and slow-5 bands,and Spearman or Pearson correlation analysis was used to assess the correlation between ALFF changes and clinical ophthalmic parameters in POAG patients.Receiver operating characteristic(ROC)curves were used to evaluate the diagnostic performance of the ALFF.RESULTS:There were 16 males in POAG patients(median age 48y)and 12 males in HCs(median age 39y).Compared with HCs,POAG patients presented increased or decreased ALFF values in different brain regions,and similar changes were observed in mild POAG patients.The ALFF values were correlated with retinal nerve fiber layer(RNFL)thickness,inner limiting membrane-retinal pigment epithelium thickness changes and the degree of visual field defects.Analysis of the diagnostic value of the ALFF via ROC curves revealed that the right medial frontal gyrus[area under the curve(AUC)=0.9063]and superior frontal gyrus(AUC=0.9097)had better diagnostic value than did the optic disc area(AUC=0.8019),visual field index(VFI%,AUC=0.8988)and macular parameters.CONCLUSION:POAG patients present altered cortical function that is significantly correlated with the optic nerve and retinal thickness and had good diagnostic value,which may reflect the underlying neuropathological mechanism of POAG.展开更多
AIM:To build a functional generalized estimating equation(GEE)model to detect glaucomatous visual field progression and compare the performance of the proposed method with that of commonly employed algorithms.METHODS:...AIM:To build a functional generalized estimating equation(GEE)model to detect glaucomatous visual field progression and compare the performance of the proposed method with that of commonly employed algorithms.METHODS:Totally 716 eyes of 716 patients with primary open angle glaucoma(POAG)with at least 5 reliable 24-2 test results and 2y of follow-up were selected.The functional GEE model was used to detect perimetric progression in the training dataset(501 eyes).In the testing dataset(215 eyes),progression was evaluated the functional GEE model,mean deviation(MD)and visual field index(VFI)rates of change,Advanced Glaucoma Intervention Study(AGIS)and Collaborative Initial Glaucoma Treatment Study(CIGTS)scores,and pointwise linear regression(PLR).RESULTS:The proposed method showed the highest proportion of eyes detected as progression(54.4%),followed by the VFI rate(34.4%),PLR(23.3%),and MD rate(21.4%).The CIGTS and AGIS scores had a lower proportion of eyes detected as progression(7.9%and 5.1%,respectively).The time to detection of progression was significantly shorter for the proposed method than that of other algorithms(adjusted P≤0.019).The VFI rate displayed moderate pairwise agreement with the proposed method(k=0.47).CONCLUSION:The functional GEE model shows the highest proportion of eyes detected as perimetric progression and the shortest time to detect perimetric progression in patients with POAG.展开更多
AIM:To explore the mechanical indices used for differential diagnosis and to investigate the relationship between ocular biomechanics and glaucoma severity within each group.METHODS:This cross-sectional study included...AIM:To explore the mechanical indices used for differential diagnosis and to investigate the relationship between ocular biomechanics and glaucoma severity within each group.METHODS:This cross-sectional study included 185 eyes from 185 subjects:62 normal controls,91 hightension glaucoma(HTG),and 32 normal-tension glaucoma(NTG)patients.All participants underwent a comprehensive ophthalmic examination that involved ocular biomechanical measurements.Glaucoma severity was assessed using visual field index(VFI),mean deviation(MD),pattern standard deviation(PSD)and retinal nerve fiber layer(RNFL)thickness.Multivariable models were used to compare fifteen biomechanical parameters among the three groups adjusting for age,gender,intraocular pressure(IOP),central corneal thickness(CCT),and axial length(AL).The generalized linear model was utilized for multifactor comparison.RESULTS:Significant differences in first applanation time(AT1),highest concavity time(HC time),stress strain index(SSI),and HC deflection were found among the three groups(P<0.05).AT1 was significantly higher in the HTG group compared to controls(P<0.05),and SSI was higher in HTG than NTG(P<0.05).HC deflection in the HTG group was significantly smaller than in NTG(P<0.05).Furthermore,AT1 levels were observed to be significantly higher in primary open angle glaucoma(POAG)patients compared to controls(P<0.05).Receiver operating charactristic(ROC)analysis showed HC deflection had an area under the curve(AUC)of 0.802 between HTG and NTG.A negatively significant correlation was observed between SSI and VFI in POAG patients.CONCLUSION:Biomechanical analysis reveals that corneas in POAG patients are stiffer than normal controls,with increased corneal stiffness correlating with more severe glaucomatous damage.Interestingly,stiffer corneas in NTG patients appeares protective.In addition,HC deflection may be useful for differentiating HTG and NTG.展开更多
AIM:To evaluate the efficacy and safety of microcatheterassisted 360-degree trabeculotomy combined with trabeculectomy(MATT-Trab)for treating refractory glaucoma.METHODS:Patients with refractory glaucoma who underwent...AIM:To evaluate the efficacy and safety of microcatheterassisted 360-degree trabeculotomy combined with trabeculectomy(MATT-Trab)for treating refractory glaucoma.METHODS:Patients with refractory glaucoma who underwent MATT-Trab were retrospectively examined.Efficacy indicators for research statistics included the intraocular pressure(IOP)level,degree of decrease,changes in medication dosage,and success rate.Safety indicators included the best-corrected visual acuity and incidence of complications.RESULTS:This study comprised 31 patients,including 11 males and 20 females,with ages ranging from 8mo to 67y(mean age:29.40±22.10y).The average postoperative IOP at 1d,1wk,1mo,3mo,6mo,1y,and the last followup was significantly lower than the average preoperative IOP(31.33±9.24 mm Hg,P<0.05).The average number of postoperative medications at 1y was 0.48±1.51,which was significantly reduced compared to that used preoperatively(3.77±0.99,P=0.00).The absolute and qualified success rates were 45.16% and 83.87%,respectively.Visual acuity exhibited no statistically significant difference between the postoperative and preoperative follow-up time points,except for the first day after surgery.The most common postoperative complications were anterior chamber hemorrhage(25 cases,86.21%)and high IOP(10 cases,34.48%).CONCLUSION:Our results indicate that MATT-Trab is effective and safe for treating refractory glaucoma.展开更多
AIM:To investigate the role of adipokines in primary open angle glaucoma(POAG)by comparing the levels of these molecules in the aqueous humor among POAG patients and cataract patients with or without metabolic disorde...AIM:To investigate the role of adipokines in primary open angle glaucoma(POAG)by comparing the levels of these molecules in the aqueous humor among POAG patients and cataract patients with or without metabolic disorders.METHODS:In this cross-sectional study,aqueous humor samples of 22 eyes of POAG patients(POAG group),24 eyes of cataract patients without metabolic disorders(cataract group),and 24 eyes of cataract patients with metabolic disorders(cataract+metabolic disorders group)were assessed for 15 adipokines by Luminex bead-based multiplex array.The correlation between aqueous humor adipokines and clinical indicators of POAG was analyzed and compared across the groups.RESULTS:The analysis revealed that the levels of adiponectin,leptin,adipsin,retinol-binding protein 4(RBP4),angiopoietin-2,angiopoietin-like protein 4(ANGPTL4),chemokine(C-C motif)ligand 2(CCL2),interleukin-8(IL-8),and interleukin-18(IL-18)in the aqueous humor of the POAG group were significantly higher than those in the cataract group.Additionally,the level of angiopoietin-2 in the POAG group was higher than in the cataract+metabolic disorders group.However,no significant correlation was found between the levels of adipokines in the POAG group and intraocular pressure(IOP),severity of POAG,or the use of glaucoma medications.CONCLUSION:This study demonstrates significant differences in aqueous humor adipokine levels between POAG and cataract patients.The findings suggest that the levels of aqueous humor adipokines may reflect the inflammatory states in POAG and systemic metabolic abnormalities.展开更多
AIM:To assess the effect of the coronavirus disease 2019(COVID-19)pandemic on the wait times and severity of surgical glaucoma cases in a single tertiary referral center in Quebec,Canada.METHODS:Preoperative severity ...AIM:To assess the effect of the coronavirus disease 2019(COVID-19)pandemic on the wait times and severity of surgical glaucoma cases in a single tertiary referral center in Quebec,Canada.METHODS:Preoperative severity data included mean visual field(VF)deficit,intraocular pressure(IOP),the number of topical glaucoma medication classes,and preoperative best corrected visual acuity(BCVA).The times from referral to procedure(referral time)and from listing date to procedure(waitlisting time)were calculated.RESULTS:This retrospective cohort study involved 181 eyes of patients undergoing glaucoma surgery from March 1 to June 30,2019(pre-pandemic period),and 201 eyes in the same timeframe in 2021(pandemic period)at Saint-Sacrement Hospital in Quebec City.There was no significant difference in the severity data of surgical glaucoma across both periods(VF deficit:P=0.48;IOP:P=0.14;BCVA:P=0.24;topical medication classes:P=0.27).The number of patients referred with oral glaucoma medication increased slightly from 45 to 70 in 2019 and 2021 respectively(P=0.08).Delay data were also comparable.Mean referral time was 122±120d in 2019 versus 144±136d in 2021(P=0.09),whereas waitlisting time before the pandemic was 43±44.5 versus 39±41.8d in 2021(P=0.13).CONCLUSION:Despite North America’s strictest pandemic restrictions,limited negative impact is observed on waitlisting delays and the severity of glaucoma cases presenting at our center.A larger subset of patients is treated with oral medications indicating a possible increase in advanced glaucoma.展开更多
Dear Editor,We present the reported case of steroid-induced glaucoma(SIG)treated by trabeculectome tunneling trabeculoplasty(3T).The 3T procedure is a new minimally invasive glaucoma surgery designed to protect and en...Dear Editor,We present the reported case of steroid-induced glaucoma(SIG)treated by trabeculectome tunneling trabeculoplasty(3T).The 3T procedure is a new minimally invasive glaucoma surgery designed to protect and enhance the function of the trabecular meshwork(TM)while reducing resistance to outflow of atrial fluid^([1]).A 20-year-old male patient experienced an elevation in intraocular pressure(IOP)and subsequently progressed to SIG after continuously using tobramycin-dexamethasone eyedrops for one year.Trabeculotomy of the right eye was performed.展开更多
AIM:To evaluate the one-year clinical outcomes of a novel canaloplasty device used in combination with cataract extraction(CE)in patients with mild to severe open angle glaucoma(OAG).METHODS:This study reviewed patien...AIM:To evaluate the one-year clinical outcomes of a novel canaloplasty device used in combination with cataract extraction(CE)in patients with mild to severe open angle glaucoma(OAG).METHODS:This study reviewed patients diagnosed with mild to severe OAG,who underwent canaloplasty with the STREAMLINE®Surgical System combined with CE.The primary outcome was surgical success,defined as achieving≥20%intraocular pressure(IOP)reduction and/or a reduction of≥1 glaucoma medication compared to baseline.Secondary outcomes included mean IOP,average number of glaucoma medications,and best-corrected distance visual acuity(BCDVA).Data was collected preoperatively and at multiple postoperative time points up to one year.RESULTS:A total of 68 eyes of 47 patients were included with mean age was 73.1±7.0y and 60%were females.Surgical success at one year was achieved in 68.8%of eyes,with 67.6%success in mild,80.0%in moderate,and 66.7%in severe OAG cases.IOP was significantly reduced from a baseline of 16.1±0.5 to 14.7±0.4 mm Hg at one year(P=0.0004).The number of medications decreased significantly in all eyes from a baseline of 1.2±0.1 to 0.6±0.1 at one year(P<0.0001).When stratified by glaucoma severity,only the mild group experienced a statistically significant decrease from a baseline of 1.1±0.1 to 0.4±0.1(P<0.0001).BCDVA improved significantly from baseline to one year.No sight-threatening complications were reported.CONCLUSION:Canaloplasty using the STREAMLINE®surgical system combined with CE effectively reduces IOP at one year in mild to severe OAG with minimal complications.IOP lowering efficacy,reduction in IOP lowering medications,and safety in moderate to severe OAG require further study.展开更多
AIM:To present a case series of rapid-onset neovascular glaucoma(NVG)accompanied by vitreous haemorrhage(VH)following cataract surgery in diabetic patients,and to evaluate the efficacy of pars plana vitrectomy(PPV)com...AIM:To present a case series of rapid-onset neovascular glaucoma(NVG)accompanied by vitreous haemorrhage(VH)following cataract surgery in diabetic patients,and to evaluate the efficacy of pars plana vitrectomy(PPV)combined with Ahmed glaucoma valve(AGV)implantation.METHODS:This is a retrospective,single-center,consecutive case series.All patients underwent 23-gauge PPV with AGV implantation 2–3d after intravitreal ranibizumab injection(IVR).The minimum postoperative follow-up period lasted 12mo.The primary outcome measures included bestcorrected visual acuity(BCVA),intraocular pressure(IOP),and topical hypotensive medications.RESULTS:Fifteen diabetic patients(age,46–81y)with rapid-onset NVG and VH following uncomplicated phacoemulsification were included.The median time to the initial NVG diagnosis following cataract surgery was within 4wk.After PPV combined with AGV implantation,the mean BCVA(logMAR)improved from 1.9(range:1.0 to 2.6)preoperatively to 1.2(range:0.2 to 2.6)at the final follow-up.Baseline BCVA and the presence of diabetic nephropathy(DN)were significantly associated with the final BCVA in the multiple regression model.The mean postoperative IOP at all follow-up visits was significantly reduced compared to baseline.At the final follow-up,9 patients required one or two topical ocular hypotensive medications,while the other 6 needed not.Success was achieved in 87%,and the reoperation rate was 20%.The majority of NVG cases(9/15)were primarily attributed to the rapid progression of proliferative diabetic retinopathy.However,a notable subset(6 eyes)was complicated retinal vein occlusion or carotid artery occlusion.CONCLUSION:PPV combined with AGV implantation after adjuvant IVR for rapid-onset NVG with VH following diabetic cataract surgery is one of the safe and effective treatments.Baseline BCVA and preexisting DN may be potential indicators for visual outcomes.展开更多
Given the alarmingly increasing rates of glaucoma worldwide and the lack of satisfactory treatments,there is a dire need to explore more feasible treatment options.Magnesium(Mg)is an essential element in maintaining t...Given the alarmingly increasing rates of glaucoma worldwide and the lack of satisfactory treatments,there is a dire need to explore more feasible treatment options.Magnesium(Mg)is an essential element in maintaining the functional and structural integrity of vital ocular tissues,but Mg and its alloys are rarely mentioned in ophthalmic applications.Our previous research found that hydroxyapatite-coated Mg(Mg@HA)shows the best biocompatibility and bioactivity,and exhibits the effect of inhibiting fibrosis after filtration surgery in the rabbit model,which is expected to be a promising material for glaucoma drainage device.In this study,we further demonstrated the anti-fibrosis effect of Mg@HA from the molecular signal level and the efficacy of implantation in the rabbit filtration surgery model.In vitro experiments showed the surface modification of Mg affects the adhesion behavior and the reorganization of cytoskeleton of Human Western blot analysis and immunofluorescence found that Mg@HA regulates the adhesion and motility of human Tenon’s capsule fibroblasts mainly by down-regulating the phosphorylation of Smad2 and Smad3 in the canonical transforming growth factor-beta(TGF-β)signaling pathway.By observing and recording the condition of filtering blebs and intraocular pressure after surgery,the effectiveness of Mg@HA applied in the rabbit filtration surgery model was further evaluated.In conclusion,the application of hydroxyapatite-coated Mg in the eye has good biocompatibility and has the potential to resist postoperative glaucoma filtration fibrosis,which may be mediated by the regulation of the TGFβ/Smad signaling pathway.展开更多
AIM:To assess the efficacy and safety of ultrasound cycloplasty(UCP)in lowering intraocular pressure(IOP)among Chinese patients suffering from refractory glaucoma.METHODS:In this 12-month retrospective study,28 patien...AIM:To assess the efficacy and safety of ultrasound cycloplasty(UCP)in lowering intraocular pressure(IOP)among Chinese patients suffering from refractory glaucoma.METHODS:In this 12-month retrospective study,28 patients with refractory glaucoma(IOP≥25 mm Hg)were treated with 8-second UCP using either 8 or 10 probe sectors.The principal measure of efficacy was the decrease in IOP at the following intervals after UCP:1d,1,3,6,and 12mo,with each measurement compared to baseline.RESULTS:Mean IOP(in mm Hg)was reduced from 46.8±8.9 to 24.5±3.2,27.0±4.8,29.1±4.6,26.1±4.5,and 28.3±4.8 at 1d,1,3,6,and 12mo postoperatively,respectively.Compared to baseline,IOP reductions at these time points were 45.0%,39.9%,35.3%,41.4%,and 36.7%,respectively.Most patients experienced relief from ocular pain after surgery.No cases of choroidal detachment or hypotony was observed.CONCLUSION:UCP is effective in reducing IOP among Chinese patients with refractory glaucoma and shows a favorable safety profile.展开更多
The prevalence of glaucoma, the second leading cause of global blindness, is increasing due to aging populations. In glaucoma, degeneration of the optic nerve and retinal ganglion cells(RGCs) causes visual field defec...The prevalence of glaucoma, the second leading cause of global blindness, is increasing due to aging populations. In glaucoma, degeneration of the optic nerve and retinal ganglion cells(RGCs) causes visual field defects and eventual blindness.展开更多
Neuronal injury in glaucoma persists despite effective intraocular pressure(IOP)control,necessitating neuroprotective strategies for retinal ganglion cells(RGCs).In this study,we investigated the neuroprotective role ...Neuronal injury in glaucoma persists despite effective intraocular pressure(IOP)control,necessitating neuroprotective strategies for retinal ganglion cells(RGCs).In this study,we investigated the neuroprotective role of theγ-hydroxybutyrate analog HOCPCA in a glaucoma model,focusing on its effects on CaMKII signaling,oxidative stress,and neuroinflammatory responses.Retinal tissue from high IOP animal models was analyzed via proteomics.In vitro mouse retinal explants were subjected to elevated pressure and oxidative stress,followed by HOCPCA treatment.HOCPCA significantly mitigated the RGC loss induced by oxidative stress and elevated pressure,preserving neuronal function.It restored CaMKIIαandβlevels,preserving RGC integrity,while also modulating oxidative stress and neuroinflammatory responses.These findings suggest that HOCPCA,through its interaction with CaMKII,holds promise as a neuroprotective therapy for glaucoma.展开更多
Glaucoma,a leading cause of blindness,demands early detection for effective management.While AI-based diagnostic systems are gaining traction,their performance is often limited by challenges such as varying image back...Glaucoma,a leading cause of blindness,demands early detection for effective management.While AI-based diagnostic systems are gaining traction,their performance is often limited by challenges such as varying image backgrounds,pixel intensity inconsistencies,and object size variations.To address these limitations,we introduce an innovative,nature-inspired machine learning framework combining feature excitation-based dense segmentation networks(FEDS-Net)and an enhanced gray wolf optimization-supported support vectormachine(IGWO-SVM).This dual-stage approach begins with FEDS-Net,which utilizes a fuzzy integral(FI)technique to accurately segment the optic cup(OC)and optic disk(OD)from retinal images,even in the presence of uncertainty and imprecision.In the second stage,the IGWO-SVM model optimizes the SVM classification process,leveraging a gray wolf-inspired optimization strategy to fine-tune the kernel function for superior accuracy.Extensive testing on three benchmark glaucoma image databases DRIONS-DB,Drishti-GS,and Rim-One-r3 demonstrates the efficacy of our method,achieving classification accuracies of 97.65%,94.88%,and 93.2%,respectively.These results surpass existing state-of-the-art techniques,offering a promising solution for reliable and early glaucoma detection.展开更多
AIM:To evaluate the short-term efficacy and safety of ultrasound cycloplasty(UCP)procedure in Chinese patients with angle-closure glaucoma(ACG),and the mechanisms of its intraocular pressure(IOP)lowering effects.METHO...AIM:To evaluate the short-term efficacy and safety of ultrasound cycloplasty(UCP)procedure in Chinese patients with angle-closure glaucoma(ACG),and the mechanisms of its intraocular pressure(IOP)lowering effects.METHODS:Fifty-six patients(56 eyes)diagnosed with primary and/or secondary ACG were enrolled in this prospective study.Visual acuity,IOP,slit-lamp examinations,structural parameters of anterior segments including anterior chamber depth(ACD),pupillary diameter(PD),anterior chamber area(ACAr),anterior chamber angle(ACAn),and side effects were evaluated.Seven rhesus macaques(Macaca Mulatta)were used for the analyses of IOP lowering effects,including inflammatory reactions,pathohistological evaluation,scanning electron microscopy(SEM),and aqueous outflow pathway via 1%basic fuchsin perfusion.RESULTS:Fifty six eyes of 24 male and 32 female patients with an average age of 58.93±15.97 years old were recruited in primary and secondary ACG affected 31 and 25 eyes,respectively.Clinically,the mean IOP was 17.89±7.93 mm Hg(n=53,53.63%reduction,P<0.001)at 1wk and 22.47±12.00 mm Hg at 12mo(n=16,18.67%reduction,P<0.01)after UCP,compared to the baseline of 39.08±14.75 mm Hg(n=56).Postoperative tolerance was favorable in 94.64%of cases,with visual acuity unchanged or improved in 96.43%of patients.Mild and transient inflammatory reactions were observed post UCP.UBM analysis revealed statistically significant changes in anterior chamber parameters:increased ACD(n=22,P<0.05),enlarged PD(n=22,P<0.05),expanded ACAr(n=16,P<0.01),and widened ACAn(n=19,P<0.05)compared to preoperative measurements.As in normal monkey eyes,IOP was also reduced upon UCP.Mild inflammatory reactions were seen 1-7d post treatment.Hematoxylin and Eosin(H&E)staining showed enlarged spaces among ciliary muscle bundles.Ciliary process stromal edema was evident,but significant loss of two layers of ciliary epitheliums was not seen.SEM confirmed ciliary muscle fibers concentrated.Fuchsin anterior chamber perfusion showed the whole ciliary body staining in UCP group,but only surface staining in controls.CONCLUSION:UCP is efficient and safe to lower the IOP of patients with ACG.Changed anterior chamber structure and increased aqueous humour outflow via uveoscleral pathway may significantly attribute to IOP lowering effects of UCP.展开更多
Glaucoma,a degenerative optic neuropathy,causes retinal ganglion cell(RGC)apoptosis and irreversible vision loss.Current therapies often fail to stop disease progression despite lowering intraocular pressure,the main ...Glaucoma,a degenerative optic neuropathy,causes retinal ganglion cell(RGC)apoptosis and irreversible vision loss.Current therapies often fail to stop disease progression despite lowering intraocular pressure,the main risk factor.Thus,neuroprotective strategies have gained interest.We performed a bibliometric analysis to determine global publishing trends and relationships among prolific authors,publications,institutions,funding agencies,and journals.We also analyzed author keywords to identify research hotspots in glaucoma neuroprotection.Further,based on keyword analysis,we reviewed most recent literature to understand mechanistic pathways underlying glaucomarelated pathophysiological responses leading to RGC loss.Bibliographic data were sourced from Scopus.Basic bibliographic features were characterized using Scopus’s functions.VOSviewer was used for mapping and visualizing bibliometric networks.The analysis included trends in publications since 2000,the most prolific countries,institutions,authors,and the strength of their linkages.A significant increase in publication output over the past two decades was noted.The United States leads in funding support,research output,and citation links,followed by China and the UK.Among the top 10 most cited authors,three are from Japanese institutions.Keyword analysis shows a focus on molecular targets related to ischemia,excitotoxicity,inflammation,and oxidative stress,with fewer emerging drug candidates and limited clinical trials.Based on the most recent literature,emerging molecular targets underlying these key pathophysiological mechanisms are summarized.In conclusion,while pathophysiology and molecular mechanisms are the current focus,there is not much progress in developing new drug candidates and conducting clinical trials.展开更多
文摘AIM:To investigate the efficacy and safety of 90°inferonasal sectoral goniotomy with an micro-vitreoretinal(MVR)blade in patients with mild-to-moderate primary open-angle glaucoma(POAG)and pseudoexfoliation glaucoma(PEXG).METHODS:This retrospective study included data from 60 patients(60 eyes)who underwent stand-alone goniotomy or goniotomy with phacoemulsification between August 2021 and January 2023,and 45 eyes underwent goniotomy combined with phacoemulsification,and 15 eyes underwent goniotomy as a stand-alone procedure.Postoperatively,intraocular pressure(IOP)and the number of medications were collected at 1,3,6,and 12 mo.The side effects of surgery were recorded 1 d,1 wk,and 1,3,6,and 12 mo postoperatively.The primary outcomes were a reduction in IOP of at least 20%from baseline and a decrease in the number of antiglaucomatous medications in 1 a postoperatively.The secondary outcome was surgical success,defined as an IOP<18 mmHg with(qualified)or without(complete)antiglaucomatous medication at 1 a postoperatively.RESULTS:At the end of 1 a,78%of patients achieved both a>20%reduction in IOP and a reduction in the number of medications used.Overall success was achieved in 63%of patients.Microhyphaema was the most common complication,none of the patients experienced a complication requiring surgical intervention.CONCLUSION:Sectoral inferonasal goniotomy with an MVR blade significantly reduced IOP and the number of medications required in patients with POAG and PEXG,and 1-year follow-up after goniotomy showed that the need for filtering surgery was either eliminated or delayed in a significant number of patients.
基金Suppotred by Tianjin Key Medical Discipline Construction Project(No.TJYXZDXK-3-004A-2).
文摘AIM:To present an overview of the research on global glaucoma treatment in the last decade in terms of publication year,journals,countries/regions,organizations,references,and keywords,to investigate the current research international trends and hot topics in this area.METHODS:Bibliometric analysis was conducted on 9128 articles in the Web of Science Core Collection(WoSCC;Clarivate)database.Quantitative and qualitative analysis was employed using VOSviewer(v1.6.18),Pajek(v1.0.0.0),and CiteSpace(v6.1.R2)software.RESULTS:The 9128 papers relating to glaucoma treatment were published from April 2013 to April 2023,of which 7482 articles(82%)were original research articles and 1464(18%)were review articles.The United States(2867)and Johns Hopkins University(166)were the most productive country and institution,respectively,but the University College London had the highest h-index(54).The Journal of Glaucoma was the most productive and Ophthalmology had the highest h-index compared with other journals.The Keywords of interest included treatment surgery,cyclophotocoagulation,minimally invasive glaucoma surgery(MIGS),trabeculectomy,baerveldt,epidemiology,medication adherence,nanoparticle,optical coherence tomography(OCT),gene therapy,and artificial intelligence(AI).Glaucoma surgery appeared as a current research hotspot through the analysis of keywords.CONCLUSION:This study provides insights into the research trends and potential research hotspots in the treatment of glaucoma.This will help researchers to evaluate research policies and to promote international cooperation.
基金supported by a Ph.D.scholarship from the YLSY program of the Republic of Turkiye,Ministry of National Educationfunded by Fight for Sight UK,grant reference#5183/5184。
文摘Glaucoma is characterized by chronic progressive optic nerve damage and retinal ganglion cell death.Although extensive research has been conducted on neuroprotection for retinal ganglion cells,there is still no treatment for clinical use.Recent evidence shows that extracellular vesicles isolated from a variety of stem cells are efficacious in retinal ganglion cell neuroprotection.In this study,we tested the novel extracellular vesicle source of the retinal progenitor R-28 cell line in vitro and in vivo.We isolated and characterized extracellular vesicles from R-28 cells and tested their therapeutic efficacy in terms of retinal ganglion cell survival in vitro and in an in vivo glaucoma model,measuring retinal ganglion cell survival and preservation of their axons.Additionally,we tested extracellular vesicles for their neuroprotective capacity in retinal ganglion cells differentiated from human embryonic stem cells.Finally,we investigated miRNA changes in retinal ganglion cells with R-28 extracellular vesicle treatment,and predicted possible pathways that may be modulated.R-28 extracellular vesicles improved retinal ganglion cell survival but failed to preserve axons significantly.Moreover,the results also illustrated the neuroprotection of R-28 extracellular vesicles on human retinal ganglion cells.Finally,we also showed changes in hsa-miRNA-4443,hsa-miRNA-216a-5p,hsa-let-7e-5p,hsa-miRNA-374b-5p,hsa-miRNA-331-3p,and hsa-miRNA-421 expressions,which may have neuroprotective potential on retinal ganglion cell degeneration.This study will pave the way for miRNA and extracellular vesicle-based neuroprotective therapies for glaucoma.
基金supported by St.Erik Eye Hospital philanthropic donations,Vetenskapsrådet 2022-00799(to PAW).
文摘Neurodegenerative diseases account for a large and increasing health and economic burden worldwide.With an increasingly aged population,this burden is set to increase.Optic neuropathies make up a large proportion of neurodegenerative diseases with glaucoma being highly prevalent.Glaucoma is characterized by the progressive dysfunction and loss of retinal ganglion cells and their axons which make up the optic nerve.It is the leading cause of irreversible vision loss and affects an estimated 80 million people.The mammalian central nervous system is non-regenerative and,once lost or injured,retinal ganglion cells cannot regenerate an axon into the optic nerve under basal conditions.Thus,strategies that provide neuroprotection to stressed,dysfunctional,or dying retinal ganglion cells are likely to be of high therapeutic and translational value.Advancing age,genetics,and elevated intraocular pressure are all major risk factors for glaucoma,however,all clinically available glaucoma treatments focus on intraocular pressure management and do not directly address the neurodegenerative component of glaucoma.
基金Supported by National Natural Science Foundation of China(No.82260203).
文摘AIM:To study the relationships between amplitude of low-frequency fluctuations(ALFF)changes and clinical ophthalmic parameters in patients with primary open angle glaucoma(POAG)and analyze the diagnostic value of ALFF.METHODS:Twenty-four POAG patients and 24 healthy controls(HCs)underwent resting-state functional magnetic resonance imaging(rs-fMRI).Nonparametric rank-sum tests were used to compare the ALFF values in the slow-4 and slow-5 bands,and Spearman or Pearson correlation analysis was used to assess the correlation between ALFF changes and clinical ophthalmic parameters in POAG patients.Receiver operating characteristic(ROC)curves were used to evaluate the diagnostic performance of the ALFF.RESULTS:There were 16 males in POAG patients(median age 48y)and 12 males in HCs(median age 39y).Compared with HCs,POAG patients presented increased or decreased ALFF values in different brain regions,and similar changes were observed in mild POAG patients.The ALFF values were correlated with retinal nerve fiber layer(RNFL)thickness,inner limiting membrane-retinal pigment epithelium thickness changes and the degree of visual field defects.Analysis of the diagnostic value of the ALFF via ROC curves revealed that the right medial frontal gyrus[area under the curve(AUC)=0.9063]and superior frontal gyrus(AUC=0.9097)had better diagnostic value than did the optic disc area(AUC=0.8019),visual field index(VFI%,AUC=0.8988)and macular parameters.CONCLUSION:POAG patients present altered cortical function that is significantly correlated with the optic nerve and retinal thickness and had good diagnostic value,which may reflect the underlying neuropathological mechanism of POAG.
基金Supported by the Korea Health Technology R&D Project through the Korea Health Industry Development Institute(KHIDI),funded by the Ministry of Health&Welfare,Republic of Korea(No.HR20C0026)the National Research Foundation of Korea(NRF)(No.RS-2023-00247504)the Patient-Centered Clinical Research Coordinating Center,funded by the Ministry of Health&Welfare,Republic of Korea(No.HC19C0276).
文摘AIM:To build a functional generalized estimating equation(GEE)model to detect glaucomatous visual field progression and compare the performance of the proposed method with that of commonly employed algorithms.METHODS:Totally 716 eyes of 716 patients with primary open angle glaucoma(POAG)with at least 5 reliable 24-2 test results and 2y of follow-up were selected.The functional GEE model was used to detect perimetric progression in the training dataset(501 eyes).In the testing dataset(215 eyes),progression was evaluated the functional GEE model,mean deviation(MD)and visual field index(VFI)rates of change,Advanced Glaucoma Intervention Study(AGIS)and Collaborative Initial Glaucoma Treatment Study(CIGTS)scores,and pointwise linear regression(PLR).RESULTS:The proposed method showed the highest proportion of eyes detected as progression(54.4%),followed by the VFI rate(34.4%),PLR(23.3%),and MD rate(21.4%).The CIGTS and AGIS scores had a lower proportion of eyes detected as progression(7.9%and 5.1%,respectively).The time to detection of progression was significantly shorter for the proposed method than that of other algorithms(adjusted P≤0.019).The VFI rate displayed moderate pairwise agreement with the proposed method(k=0.47).CONCLUSION:The functional GEE model shows the highest proportion of eyes detected as perimetric progression and the shortest time to detect perimetric progression in patients with POAG.
基金Supported by the Science&Technology Department of Sichuan Province(China)Funding Project(No.2021YFS0221,No.2023YFS0179)1.3.5 Project for Disciplines of ExcellenceWest China Hospital,Sichuan University(No.2022HXFH032,ZYJC21058,2021-023,2022-014).
文摘AIM:To explore the mechanical indices used for differential diagnosis and to investigate the relationship between ocular biomechanics and glaucoma severity within each group.METHODS:This cross-sectional study included 185 eyes from 185 subjects:62 normal controls,91 hightension glaucoma(HTG),and 32 normal-tension glaucoma(NTG)patients.All participants underwent a comprehensive ophthalmic examination that involved ocular biomechanical measurements.Glaucoma severity was assessed using visual field index(VFI),mean deviation(MD),pattern standard deviation(PSD)and retinal nerve fiber layer(RNFL)thickness.Multivariable models were used to compare fifteen biomechanical parameters among the three groups adjusting for age,gender,intraocular pressure(IOP),central corneal thickness(CCT),and axial length(AL).The generalized linear model was utilized for multifactor comparison.RESULTS:Significant differences in first applanation time(AT1),highest concavity time(HC time),stress strain index(SSI),and HC deflection were found among the three groups(P<0.05).AT1 was significantly higher in the HTG group compared to controls(P<0.05),and SSI was higher in HTG than NTG(P<0.05).HC deflection in the HTG group was significantly smaller than in NTG(P<0.05).Furthermore,AT1 levels were observed to be significantly higher in primary open angle glaucoma(POAG)patients compared to controls(P<0.05).Receiver operating charactristic(ROC)analysis showed HC deflection had an area under the curve(AUC)of 0.802 between HTG and NTG.A negatively significant correlation was observed between SSI and VFI in POAG patients.CONCLUSION:Biomechanical analysis reveals that corneas in POAG patients are stiffer than normal controls,with increased corneal stiffness correlating with more severe glaucomatous damage.Interestingly,stiffer corneas in NTG patients appeares protective.In addition,HC deflection may be useful for differentiating HTG and NTG.
文摘AIM:To evaluate the efficacy and safety of microcatheterassisted 360-degree trabeculotomy combined with trabeculectomy(MATT-Trab)for treating refractory glaucoma.METHODS:Patients with refractory glaucoma who underwent MATT-Trab were retrospectively examined.Efficacy indicators for research statistics included the intraocular pressure(IOP)level,degree of decrease,changes in medication dosage,and success rate.Safety indicators included the best-corrected visual acuity and incidence of complications.RESULTS:This study comprised 31 patients,including 11 males and 20 females,with ages ranging from 8mo to 67y(mean age:29.40±22.10y).The average postoperative IOP at 1d,1wk,1mo,3mo,6mo,1y,and the last followup was significantly lower than the average preoperative IOP(31.33±9.24 mm Hg,P<0.05).The average number of postoperative medications at 1y was 0.48±1.51,which was significantly reduced compared to that used preoperatively(3.77±0.99,P=0.00).The absolute and qualified success rates were 45.16% and 83.87%,respectively.Visual acuity exhibited no statistically significant difference between the postoperative and preoperative follow-up time points,except for the first day after surgery.The most common postoperative complications were anterior chamber hemorrhage(25 cases,86.21%)and high IOP(10 cases,34.48%).CONCLUSION:Our results indicate that MATT-Trab is effective and safe for treating refractory glaucoma.
基金Supported by National Key R&D Program of China(No.2023YFC2506100)the Changping Key Research Project of the Beijing Natural Science Foundation Program(No.L234016).
文摘AIM:To investigate the role of adipokines in primary open angle glaucoma(POAG)by comparing the levels of these molecules in the aqueous humor among POAG patients and cataract patients with or without metabolic disorders.METHODS:In this cross-sectional study,aqueous humor samples of 22 eyes of POAG patients(POAG group),24 eyes of cataract patients without metabolic disorders(cataract group),and 24 eyes of cataract patients with metabolic disorders(cataract+metabolic disorders group)were assessed for 15 adipokines by Luminex bead-based multiplex array.The correlation between aqueous humor adipokines and clinical indicators of POAG was analyzed and compared across the groups.RESULTS:The analysis revealed that the levels of adiponectin,leptin,adipsin,retinol-binding protein 4(RBP4),angiopoietin-2,angiopoietin-like protein 4(ANGPTL4),chemokine(C-C motif)ligand 2(CCL2),interleukin-8(IL-8),and interleukin-18(IL-18)in the aqueous humor of the POAG group were significantly higher than those in the cataract group.Additionally,the level of angiopoietin-2 in the POAG group was higher than in the cataract+metabolic disorders group.However,no significant correlation was found between the levels of adipokines in the POAG group and intraocular pressure(IOP),severity of POAG,or the use of glaucoma medications.CONCLUSION:This study demonstrates significant differences in aqueous humor adipokine levels between POAG and cataract patients.The findings suggest that the levels of aqueous humor adipokines may reflect the inflammatory states in POAG and systemic metabolic abnormalities.
文摘AIM:To assess the effect of the coronavirus disease 2019(COVID-19)pandemic on the wait times and severity of surgical glaucoma cases in a single tertiary referral center in Quebec,Canada.METHODS:Preoperative severity data included mean visual field(VF)deficit,intraocular pressure(IOP),the number of topical glaucoma medication classes,and preoperative best corrected visual acuity(BCVA).The times from referral to procedure(referral time)and from listing date to procedure(waitlisting time)were calculated.RESULTS:This retrospective cohort study involved 181 eyes of patients undergoing glaucoma surgery from March 1 to June 30,2019(pre-pandemic period),and 201 eyes in the same timeframe in 2021(pandemic period)at Saint-Sacrement Hospital in Quebec City.There was no significant difference in the severity data of surgical glaucoma across both periods(VF deficit:P=0.48;IOP:P=0.14;BCVA:P=0.24;topical medication classes:P=0.27).The number of patients referred with oral glaucoma medication increased slightly from 45 to 70 in 2019 and 2021 respectively(P=0.08).Delay data were also comparable.Mean referral time was 122±120d in 2019 versus 144±136d in 2021(P=0.09),whereas waitlisting time before the pandemic was 43±44.5 versus 39±41.8d in 2021(P=0.13).CONCLUSION:Despite North America’s strictest pandemic restrictions,limited negative impact is observed on waitlisting delays and the severity of glaucoma cases presenting at our center.A larger subset of patients is treated with oral medications indicating a possible increase in advanced glaucoma.
基金Supported by Sichuan Provincial Administration of Traditional Chinese Medicine(No.2024MS471)。
文摘Dear Editor,We present the reported case of steroid-induced glaucoma(SIG)treated by trabeculectome tunneling trabeculoplasty(3T).The 3T procedure is a new minimally invasive glaucoma surgery designed to protect and enhance the function of the trabecular meshwork(TM)while reducing resistance to outflow of atrial fluid^([1]).A 20-year-old male patient experienced an elevation in intraocular pressure(IOP)and subsequently progressed to SIG after continuously using tobramycin-dexamethasone eyedrops for one year.Trabeculotomy of the right eye was performed.
文摘AIM:To evaluate the one-year clinical outcomes of a novel canaloplasty device used in combination with cataract extraction(CE)in patients with mild to severe open angle glaucoma(OAG).METHODS:This study reviewed patients diagnosed with mild to severe OAG,who underwent canaloplasty with the STREAMLINE®Surgical System combined with CE.The primary outcome was surgical success,defined as achieving≥20%intraocular pressure(IOP)reduction and/or a reduction of≥1 glaucoma medication compared to baseline.Secondary outcomes included mean IOP,average number of glaucoma medications,and best-corrected distance visual acuity(BCDVA).Data was collected preoperatively and at multiple postoperative time points up to one year.RESULTS:A total of 68 eyes of 47 patients were included with mean age was 73.1±7.0y and 60%were females.Surgical success at one year was achieved in 68.8%of eyes,with 67.6%success in mild,80.0%in moderate,and 66.7%in severe OAG cases.IOP was significantly reduced from a baseline of 16.1±0.5 to 14.7±0.4 mm Hg at one year(P=0.0004).The number of medications decreased significantly in all eyes from a baseline of 1.2±0.1 to 0.6±0.1 at one year(P<0.0001).When stratified by glaucoma severity,only the mild group experienced a statistically significant decrease from a baseline of 1.1±0.1 to 0.4±0.1(P<0.0001).BCDVA improved significantly from baseline to one year.No sight-threatening complications were reported.CONCLUSION:Canaloplasty using the STREAMLINE®surgical system combined with CE effectively reduces IOP at one year in mild to severe OAG with minimal complications.IOP lowering efficacy,reduction in IOP lowering medications,and safety in moderate to severe OAG require further study.
基金Supported by Shanghai Municipal Health Commission(No.202140183).
文摘AIM:To present a case series of rapid-onset neovascular glaucoma(NVG)accompanied by vitreous haemorrhage(VH)following cataract surgery in diabetic patients,and to evaluate the efficacy of pars plana vitrectomy(PPV)combined with Ahmed glaucoma valve(AGV)implantation.METHODS:This is a retrospective,single-center,consecutive case series.All patients underwent 23-gauge PPV with AGV implantation 2–3d after intravitreal ranibizumab injection(IVR).The minimum postoperative follow-up period lasted 12mo.The primary outcome measures included bestcorrected visual acuity(BCVA),intraocular pressure(IOP),and topical hypotensive medications.RESULTS:Fifteen diabetic patients(age,46–81y)with rapid-onset NVG and VH following uncomplicated phacoemulsification were included.The median time to the initial NVG diagnosis following cataract surgery was within 4wk.After PPV combined with AGV implantation,the mean BCVA(logMAR)improved from 1.9(range:1.0 to 2.6)preoperatively to 1.2(range:0.2 to 2.6)at the final follow-up.Baseline BCVA and the presence of diabetic nephropathy(DN)were significantly associated with the final BCVA in the multiple regression model.The mean postoperative IOP at all follow-up visits was significantly reduced compared to baseline.At the final follow-up,9 patients required one or two topical ocular hypotensive medications,while the other 6 needed not.Success was achieved in 87%,and the reoperation rate was 20%.The majority of NVG cases(9/15)were primarily attributed to the rapid progression of proliferative diabetic retinopathy.However,a notable subset(6 eyes)was complicated retinal vein occlusion or carotid artery occlusion.CONCLUSION:PPV combined with AGV implantation after adjuvant IVR for rapid-onset NVG with VH following diabetic cataract surgery is one of the safe and effective treatments.Baseline BCVA and preexisting DN may be potential indicators for visual outcomes.
基金supported by the National Natural Science Foundation of China(Grant No.81670860 and 81700836)Natural Science Foundation of Chongqing(Grant No.cstc2018jcyjAX0034 and cstc2018jcyjAX0016).
文摘Given the alarmingly increasing rates of glaucoma worldwide and the lack of satisfactory treatments,there is a dire need to explore more feasible treatment options.Magnesium(Mg)is an essential element in maintaining the functional and structural integrity of vital ocular tissues,but Mg and its alloys are rarely mentioned in ophthalmic applications.Our previous research found that hydroxyapatite-coated Mg(Mg@HA)shows the best biocompatibility and bioactivity,and exhibits the effect of inhibiting fibrosis after filtration surgery in the rabbit model,which is expected to be a promising material for glaucoma drainage device.In this study,we further demonstrated the anti-fibrosis effect of Mg@HA from the molecular signal level and the efficacy of implantation in the rabbit filtration surgery model.In vitro experiments showed the surface modification of Mg affects the adhesion behavior and the reorganization of cytoskeleton of Human Western blot analysis and immunofluorescence found that Mg@HA regulates the adhesion and motility of human Tenon’s capsule fibroblasts mainly by down-regulating the phosphorylation of Smad2 and Smad3 in the canonical transforming growth factor-beta(TGF-β)signaling pathway.By observing and recording the condition of filtering blebs and intraocular pressure after surgery,the effectiveness of Mg@HA applied in the rabbit filtration surgery model was further evaluated.In conclusion,the application of hydroxyapatite-coated Mg in the eye has good biocompatibility and has the potential to resist postoperative glaucoma filtration fibrosis,which may be mediated by the regulation of the TGFβ/Smad signaling pathway.
基金Supported by the Shanghai Science and Technology Committee Project Foundation(No.21Y11909700)Guangci Innovative Technology Sailing Plan(Ruijin Hospital 2022).
文摘AIM:To assess the efficacy and safety of ultrasound cycloplasty(UCP)in lowering intraocular pressure(IOP)among Chinese patients suffering from refractory glaucoma.METHODS:In this 12-month retrospective study,28 patients with refractory glaucoma(IOP≥25 mm Hg)were treated with 8-second UCP using either 8 or 10 probe sectors.The principal measure of efficacy was the decrease in IOP at the following intervals after UCP:1d,1,3,6,and 12mo,with each measurement compared to baseline.RESULTS:Mean IOP(in mm Hg)was reduced from 46.8±8.9 to 24.5±3.2,27.0±4.8,29.1±4.6,26.1±4.5,and 28.3±4.8 at 1d,1,3,6,and 12mo postoperatively,respectively.Compared to baseline,IOP reductions at these time points were 45.0%,39.9%,35.3%,41.4%,and 36.7%,respectively.Most patients experienced relief from ocular pain after surgery.No cases of choroidal detachment or hypotony was observed.CONCLUSION:UCP is effective in reducing IOP among Chinese patients with refractory glaucoma and shows a favorable safety profile.
基金supported by Japan Society for the Promotion of Science (JSPS) KAKENHI Grants-in-Aid for Scientific Research (JP22K09804 to CHJP21K09688 to XG+3 种基金JP19KK0229, JP21H04786, JP21H02819 and JP21K18279 to TH)the Shiseido Female Researcher Science Grant (to XG)Mitsubishi FoundationTakeda Science Foundation (to TH)。
文摘The prevalence of glaucoma, the second leading cause of global blindness, is increasing due to aging populations. In glaucoma, degeneration of the optic nerve and retinal ganglion cells(RGCs) causes visual field defects and eventual blindness.
基金The position of M.H.was funded by grants from the state of North-Rhine-Westphalia,Germany(AZ:323-8.04.10.02-141905)the German Center for Infection Research,DZIF(TTU 08.927 and TTU 08.928)+1 种基金the Deutsche Forschungsgemeinschaft(DFG),SFB 670 procured by Prof.Dr.Martin Krönkesupported by the Deutsche Forschungsgemeinschaft(DFG)with grants PR1569/1-1 and PR 1569/1-3.
文摘Neuronal injury in glaucoma persists despite effective intraocular pressure(IOP)control,necessitating neuroprotective strategies for retinal ganglion cells(RGCs).In this study,we investigated the neuroprotective role of theγ-hydroxybutyrate analog HOCPCA in a glaucoma model,focusing on its effects on CaMKII signaling,oxidative stress,and neuroinflammatory responses.Retinal tissue from high IOP animal models was analyzed via proteomics.In vitro mouse retinal explants were subjected to elevated pressure and oxidative stress,followed by HOCPCA treatment.HOCPCA significantly mitigated the RGC loss induced by oxidative stress and elevated pressure,preserving neuronal function.It restored CaMKIIαandβlevels,preserving RGC integrity,while also modulating oxidative stress and neuroinflammatory responses.These findings suggest that HOCPCA,through its interaction with CaMKII,holds promise as a neuroprotective therapy for glaucoma.
基金Researchers Supporting Project number(RSP2025R314),King Saud University,Riyadh,Saudi Arabia.
文摘Glaucoma,a leading cause of blindness,demands early detection for effective management.While AI-based diagnostic systems are gaining traction,their performance is often limited by challenges such as varying image backgrounds,pixel intensity inconsistencies,and object size variations.To address these limitations,we introduce an innovative,nature-inspired machine learning framework combining feature excitation-based dense segmentation networks(FEDS-Net)and an enhanced gray wolf optimization-supported support vectormachine(IGWO-SVM).This dual-stage approach begins with FEDS-Net,which utilizes a fuzzy integral(FI)technique to accurately segment the optic cup(OC)and optic disk(OD)from retinal images,even in the presence of uncertainty and imprecision.In the second stage,the IGWO-SVM model optimizes the SVM classification process,leveraging a gray wolf-inspired optimization strategy to fine-tune the kernel function for superior accuracy.Extensive testing on three benchmark glaucoma image databases DRIONS-DB,Drishti-GS,and Rim-One-r3 demonstrates the efficacy of our method,achieving classification accuracies of 97.65%,94.88%,and 93.2%,respectively.These results surpass existing state-of-the-art techniques,offering a promising solution for reliable and early glaucoma detection.
基金Supported by the National Natural Science Foundation of China(No.82471071)Fujian Provincial Natural Science Foundation of China(No.2023J011580)+1 种基金Natural Science Foundation of Xiamen,China(No.3502Z20227401)Huanhua Scholar Program and the Sichuan Provincial People’s Hospital Postdoctoral Fund(No.2022BH02).
文摘AIM:To evaluate the short-term efficacy and safety of ultrasound cycloplasty(UCP)procedure in Chinese patients with angle-closure glaucoma(ACG),and the mechanisms of its intraocular pressure(IOP)lowering effects.METHODS:Fifty-six patients(56 eyes)diagnosed with primary and/or secondary ACG were enrolled in this prospective study.Visual acuity,IOP,slit-lamp examinations,structural parameters of anterior segments including anterior chamber depth(ACD),pupillary diameter(PD),anterior chamber area(ACAr),anterior chamber angle(ACAn),and side effects were evaluated.Seven rhesus macaques(Macaca Mulatta)were used for the analyses of IOP lowering effects,including inflammatory reactions,pathohistological evaluation,scanning electron microscopy(SEM),and aqueous outflow pathway via 1%basic fuchsin perfusion.RESULTS:Fifty six eyes of 24 male and 32 female patients with an average age of 58.93±15.97 years old were recruited in primary and secondary ACG affected 31 and 25 eyes,respectively.Clinically,the mean IOP was 17.89±7.93 mm Hg(n=53,53.63%reduction,P<0.001)at 1wk and 22.47±12.00 mm Hg at 12mo(n=16,18.67%reduction,P<0.01)after UCP,compared to the baseline of 39.08±14.75 mm Hg(n=56).Postoperative tolerance was favorable in 94.64%of cases,with visual acuity unchanged or improved in 96.43%of patients.Mild and transient inflammatory reactions were observed post UCP.UBM analysis revealed statistically significant changes in anterior chamber parameters:increased ACD(n=22,P<0.05),enlarged PD(n=22,P<0.05),expanded ACAr(n=16,P<0.01),and widened ACAn(n=19,P<0.05)compared to preoperative measurements.As in normal monkey eyes,IOP was also reduced upon UCP.Mild inflammatory reactions were seen 1-7d post treatment.Hematoxylin and Eosin(H&E)staining showed enlarged spaces among ciliary muscle bundles.Ciliary process stromal edema was evident,but significant loss of two layers of ciliary epitheliums was not seen.SEM confirmed ciliary muscle fibers concentrated.Fuchsin anterior chamber perfusion showed the whole ciliary body staining in UCP group,but only surface staining in controls.CONCLUSION:UCP is efficient and safe to lower the IOP of patients with ACG.Changed anterior chamber structure and increased aqueous humour outflow via uveoscleral pathway may significantly attribute to IOP lowering effects of UCP.
基金Supported by the Ministry of Higher Education(Malaysia)(No.FRGS/1/2023/SKK15/IMU/01/1)International Medical University[No.PHMS I-2023(01)].
文摘Glaucoma,a degenerative optic neuropathy,causes retinal ganglion cell(RGC)apoptosis and irreversible vision loss.Current therapies often fail to stop disease progression despite lowering intraocular pressure,the main risk factor.Thus,neuroprotective strategies have gained interest.We performed a bibliometric analysis to determine global publishing trends and relationships among prolific authors,publications,institutions,funding agencies,and journals.We also analyzed author keywords to identify research hotspots in glaucoma neuroprotection.Further,based on keyword analysis,we reviewed most recent literature to understand mechanistic pathways underlying glaucomarelated pathophysiological responses leading to RGC loss.Bibliographic data were sourced from Scopus.Basic bibliographic features were characterized using Scopus’s functions.VOSviewer was used for mapping and visualizing bibliometric networks.The analysis included trends in publications since 2000,the most prolific countries,institutions,authors,and the strength of their linkages.A significant increase in publication output over the past two decades was noted.The United States leads in funding support,research output,and citation links,followed by China and the UK.Among the top 10 most cited authors,three are from Japanese institutions.Keyword analysis shows a focus on molecular targets related to ischemia,excitotoxicity,inflammation,and oxidative stress,with fewer emerging drug candidates and limited clinical trials.Based on the most recent literature,emerging molecular targets underlying these key pathophysiological mechanisms are summarized.In conclusion,while pathophysiology and molecular mechanisms are the current focus,there is not much progress in developing new drug candidates and conducting clinical trials.
