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
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
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 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
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 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
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
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
Dear Editor,We report a case of congenital glaucoma patient with Turner syndrome(TS)and DMPK gene mutation whose intraocular pressure(IOP)was controlled by multiple bleb revision with antiproliferation medication foll...Dear Editor,We report a case of congenital glaucoma patient with Turner syndrome(TS)and DMPK gene mutation whose intraocular pressure(IOP)was controlled by multiple bleb revision with antiproliferation medication followed by transscleral cyclophotocoagulation(TCP).展开更多
In recent years,Mendelian randomization(MR)has been increasingly utilized,leveraging genetic variants as instrumental variables.This approach significantly mitigates confounder effects and reverse causation,precisely ...In recent years,Mendelian randomization(MR)has been increasingly utilized,leveraging genetic variants as instrumental variables.This approach significantly mitigates confounder effects and reverse causation,precisely clarifying the causal links between exposures and outcomes.MR’s unique advantages have made it instrumental in medicine,especially in elucidating glaucoma’s etiology.It facilitates the identification of potential risk factors,laying the groundwork for developing preventative and therapeutic strategies against glaucoma.Recent MR research has delved into diverse potential glaucoma risk factors,including behavioral habits,metabolic profiles,and their causative linkage to the disease.This review encapsulates MR’s analysis in glaucoma etiology,heralding new avenues for understanding underlying mechanisms and establishing causality.展开更多
BACKGROUND Glaucoma is the leading cause of irreversible blindness worldwide,with 60.5 million affected individuals,of whom 11 million are from India.Due to its asymptomatic nature,the disease largely remains underdia...BACKGROUND Glaucoma is the leading cause of irreversible blindness worldwide,with 60.5 million affected individuals,of whom 11 million are from India.Due to its asymptomatic nature,the disease largely remains underdiagnosed or diagnosed in advanced stages,where little can be done to salvage functional vision.The literature suggests that a lack of knowledge is one of the reasons for its grave consequences.Assessment of awareness is the first step in planning management.Several studies have been conducted in the Indian community,but data from healthcare providers,who play a significant role in educating the masses directly or indirectly,are limited.AIM To identify awareness,knowledge,and attitudes about glaucoma among healthcare workers in a tertiary center in India.METHODS This cross-sectional study was conducted at a tertiary care institute in Eastern India.Data were collected from 423 participants by systematic stratified sampling after Institutional Ethics Committee approval via a pretested,self-designed,semistructured,validated questionnaire.Statistical analyses were performed using the Statistical Package for Social Sciences Software v22.0.Continuous variables are expressed as the means±SD for parametric values and medians with interquartile ranges for nonparametric values.The associations between the variables were studied via multivariate linear and logistic regression.P<0.05 was considered statistically significant.RESULTS Most respondents were 20–30 years old(n=345,81.6%).The knowledge regarding glaucoma was good,and almost 56.3%of the participants gained knowledge from their medical training.The majority were aware that it has a familial predisposition and is secondary to high intraocular pressure,leading to irreversible peripheral vision loss.Only 42%knew about the life-long requirements of treatment.The resident group scored highest on knowledgeand attitude-based questions,whereas the faculty group scored highest on practice-based questions.Although 62%of the nursing staff had good attitude scores,their knowledge and practice scores were lower.The occupation group response difference was statistically significant(P<0.05)for all the knowledge-based questions.CONCLUSION Although the majority of healthcare providers are aware of glaucoma,there is a dearth of knowledge about treatment modalities.Education via seminars and media can improve their knowledge,attitudes,and practices.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 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
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 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.
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 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 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 Innovation&Transfer Fund of Peking University Third Hospital(No.Y77448-06).
文摘Dear Editor,We report a case of congenital glaucoma patient with Turner syndrome(TS)and DMPK gene mutation whose intraocular pressure(IOP)was controlled by multiple bleb revision with antiproliferation medication followed by transscleral cyclophotocoagulation(TCP).
基金Supported by Shenzhen Science and Technology Program(No.JCYJ20220530152005013,No.JCYJ20230807114605011)Sanming Project of Medicine in Shenzhen(No.SZZYSM202411007).
文摘In recent years,Mendelian randomization(MR)has been increasingly utilized,leveraging genetic variants as instrumental variables.This approach significantly mitigates confounder effects and reverse causation,precisely clarifying the causal links between exposures and outcomes.MR’s unique advantages have made it instrumental in medicine,especially in elucidating glaucoma’s etiology.It facilitates the identification of potential risk factors,laying the groundwork for developing preventative and therapeutic strategies against glaucoma.Recent MR research has delved into diverse potential glaucoma risk factors,including behavioral habits,metabolic profiles,and their causative linkage to the disease.This review encapsulates MR’s analysis in glaucoma etiology,heralding new avenues for understanding underlying mechanisms and establishing causality.
文摘BACKGROUND Glaucoma is the leading cause of irreversible blindness worldwide,with 60.5 million affected individuals,of whom 11 million are from India.Due to its asymptomatic nature,the disease largely remains underdiagnosed or diagnosed in advanced stages,where little can be done to salvage functional vision.The literature suggests that a lack of knowledge is one of the reasons for its grave consequences.Assessment of awareness is the first step in planning management.Several studies have been conducted in the Indian community,but data from healthcare providers,who play a significant role in educating the masses directly or indirectly,are limited.AIM To identify awareness,knowledge,and attitudes about glaucoma among healthcare workers in a tertiary center in India.METHODS This cross-sectional study was conducted at a tertiary care institute in Eastern India.Data were collected from 423 participants by systematic stratified sampling after Institutional Ethics Committee approval via a pretested,self-designed,semistructured,validated questionnaire.Statistical analyses were performed using the Statistical Package for Social Sciences Software v22.0.Continuous variables are expressed as the means±SD for parametric values and medians with interquartile ranges for nonparametric values.The associations between the variables were studied via multivariate linear and logistic regression.P<0.05 was considered statistically significant.RESULTS Most respondents were 20–30 years old(n=345,81.6%).The knowledge regarding glaucoma was good,and almost 56.3%of the participants gained knowledge from their medical training.The majority were aware that it has a familial predisposition and is secondary to high intraocular pressure,leading to irreversible peripheral vision loss.Only 42%knew about the life-long requirements of treatment.The resident group scored highest on knowledgeand attitude-based questions,whereas the faculty group scored highest on practice-based questions.Although 62%of the nursing staff had good attitude scores,their knowledge and practice scores were lower.The occupation group response difference was statistically significant(P<0.05)for all the knowledge-based questions.CONCLUSION Although the majority of healthcare providers are aware of glaucoma,there is a dearth of knowledge about treatment modalities.Education via seminars and media can improve their knowledge,attitudes,and practices.
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.
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.
