Malignant glaucoma treated by low-dose laser cycloplasty: a 1-year multicenter prospective noncomparative study

AIM:To report a one-year clinical outcomes of low-dose laser cycloplasty(LCP)among malignant glaucoma patients.METHODS:In this prospective,multicenter,noncomparative clinical study,participants with malignant glaucoma were recruited and underwent LCP at eight ophthalmic centers in China.Patients were followed up at 1wk,1,3,6,and 12mo.Intraocular pressure(IOP),number of glaucoma medications,anterior chamber depth(ACD),and complications were recorded.Anatomical success was defined as the reformation of the anterior chamber based on slit-lamp biomicroscopy.Recurrence was defined by the presence of a shallow orflat anterior chamber after initial recovery from treatment.RESULTS:A total of 34 eyes received LCP.Mean IOP and medications decreased from 36.1±11.5 mm Hg with 3.3±1.5 glaucoma medications pre-treatment to 20.9±9.8 mm Hg(P<0.001)with 2.9±1.6 medications(P=0.046)at 1d,and 17.4±6.7 mm Hg(P<0.001)with 1.3±1.7 medications(P<0.001)at 12mo.The ACD increased from 1.1±0.8 mm at baseline to 1.7±1.0 mm and to 2.0±0.5 mm at 1d and 12mo,respectively.A total of 32(94.1%)eyes achieved initial anatomical success.During follow-up,2(5.9%)eyes failed and 8(23.5%)eyes relapsed,yielding a 12-month anatomical success rate of 64.3%.Complications including anterior synechia(8.82%),choroidal/ciliary detachment(5.88%)and hypopyon(2.94%)were observed within 1wk.CONCLUSION:LCP is simple,safe,and effective in reforming the anterior chamber in malignant glaucoma.

Patient satisfaction and follow-up adherence to glaucoma case management clinic in China

AIM:To assess glaucoma patient satisfaction and follow-up adherence in case management and identify associated predictors to improve healthcare quality and patient outcomes.METHODS:In this cross-sectional study,a total of 119 patients completed a Patient Satisfaction Questionnaire-18 and a sociodemographic questionnaire.Clinical data was obtained from the case management system.Follow-up adherence was defined as completing each follow-up within±30d of the scheduled time set by ophthalmologists during the study period.RESULTS:Average satisfaction scored 78.65±7,with an average of 4.39±0.58 across the seven dimensions.Age negatively correlated with satisfaction(P=0.008),whilst patients with follow-up duration of 2 or more years reported higher satisfaction(P=0.045).Multivariate logistics regression analysis revealed that longer follow-up durations were associated with lower follow-up adherence(OR=0.97,95%CI,0.95-1.00,P=0.044).Additionally,patients with suspected glaucoma(OR=2.72,95%CI,1.03-7.20,P=0.044)and those with an annual income over 100000 Chinese yuan demonstrated higher adherence(OR=5.57,95%CI,1.00-30.89,P=0.049).CONCLUSION:The case management model proves effective for glaucoma patients,with positive adherence rates.The implementation of this model can be optimized in the future based on the identified factors and extended to glaucoma patients in more hospitals.

Plasma microRNA profiling in nasopharyngeal carcinoma patients reveals miR-548q and miR-483-5p as potential biomarkers

MicroRNAs(miRNAs), which play a role in tumorigenesis, may also serve as diagnostic or prognostic biomarkers. However, studies on human miRNA profiles in plasma from nasopharyngeal carcinoma(NPC) patients are in their infancy. Here, we used microarrays to perform systematic profiling of human miRNAs in plasma from NPC patients. We subsequently used real-time quantitative polymerase chain reaction(Q-PCR) to validate miRNAs with aberrant expression that could serve as potential biomarkers. By comparing the plasma miRNA profiles of 31 NPC patients and 19 controls, 39 of 887 human miRNAs were found to be aberrantly expressed. Considering the fold change and P value, miR-548q and miR-483-5p were validated in 132 samples from 82 NPC patients and 50 controls. Moreover, high expression of miR-548q and miR-483-5p was further found in 3 NPC cell lines and clinical biopsy tissues from 54 NPC patients and 22 controls. Our results revealed that miR-548q and miR-483-5p are potential biomarkers of NPC. Combining the receiver operating characteristic(ROC) analyses of these 2 miRNAs, an area under the ROC curve(AUC) of 0.737 with 67.1% sensitivity and 68.0% specificity were obtained, showing the preliminary diagnostic value of plasma miRNAs. Moreover, most NPC patients with a poor outcome exhibited high expression(> median) of miR-548q(70.6%) and miR-483-5p(64.7%) in tissue samples, indicating their prognostic value. The high expression levels of miR-548q and miR-483-5p in plasma, cell lines, and clinical tissues of NPC patients indicate that their roles in NPC should be explored in the future.

A new bleb-independent surgery namely penetrating canaloplasty for corticosteroid-induced glaucoma: a prospective case series

AIM: To report the outcomes of penetrating canaloplasty for corticosteroid-induced glaucoma in a case series.METHODS: Penetrating canaloplasty is a blebindependent filtering surger y unifying canaloplasty and trabeculectomy. In this study, the surger y was performed to restore the natural outflow through surgically expanded Schlemm’s canal and generated trabeculum ostium. A total of 10 eyes of 8 patients were treated with penetrating canaloplasty for corticosteroid-induced glaucoma. Intraocular pressure(IOP) and the number of glaucoma medications at postoperative 3, 6, 12, 18, 24,36, and 48mo were documented as primary endpoint.Complications after the surgery were recorded as secondary endpoint.RESULTS: Penetrating canaloplasty was accomplished successfully for all 10 eyes, with a mean follow-up of 20.4±13.0mo(range 6-48mo). The mean preoperative IOP and number of anti-glaucoma medications were 45.1±6.5 mm Hg and 3.3±0.5 respectively. The mean post-operative IOP at 3, 6, 12, 18, 24, 36, and 48mo were 15.8±6.0, 14.7±3.3,15.3±2.0, 15.6±2.6, 17.5±1.8, 16.5±4.9, and 14.0 mm Hg.The number of anti-glaucoma medications at these time points were all 0. This surgery failed to control the IOP in 1 eye at 1mo after surgery. Hyphaema occurred in 3 eyes on the first day after surgery. Postoperative transient IOP increasing was encountered with in two eyes from 1wk to 1mo after surgery. Choroidal detachment developed in one eye but responded well to conservative treatment.CONCLUSION: Penetrating canaloplasty is effective for corticosteroid-induced glaucoma without serious complications, making it a viable or preferred alternative option.

Trend of glaucoma internal filtration surgeries in a tertiary hospital in China

AIM:To evaluate the trend of glaucoma internal filtration surgeries for inpatients between 2015 and 2021 at the Eye Hospital of Wenzhou Medical University.METHODS:A review of the medical records of inpatients who had been diagnosed with glaucoma and received antiglaucoma surgery between January 1,2015 and December 31,2021 was conducted.The glaucoma diagnosis in this study included primary open angle glaucoma,primary angleclosure glaucoma,secondary glaucoma,and paediatric glaucoma.The types of surgeries were categorised as internal filtration,external filtration,and cyclodestruction surgery based on the pathway of aqueous humor outflow.The trend of these glaucoma surgeries in the sample of patients with different types of glaucoma was then analysed.RESULTS:The number of patients hospitalised for glaucoma surgery increased yearly,from 752 in 2015 to 1373 in 2021,at the Eye Hospital of Wenzhou Medical University.Regarding the patients diagnosed with primary open angle glaucoma,internal filtration surgery increased from 27.40%of the sample to 54.40%of the sample,while external filtration surgery decreased from 71.50%to 44.20%between 2015 and 2021.For paediatric glaucoma,internal filtration surgery increased from 37.50%in 2015 to 88.20%in 2021.Whilst different types of surgeries were performed on the sample of patients with secondary glaucoma,the proportion of internal filtration surgery also showed an increase from 18.20%in 2015 to 40.90%in 2021.Meanwhile,internal filtration surgery in the patient sample with primary angle-closure glaucoma already accounted for over 70.00%in 2015,and showed a small increase by 2021.CONCLUSION:As surgical technology and surgical experience continue to elevate and improve,the range of glaucoma surgeries are correspondingly evolving.This study find that internal filtration surgeries accounted for an increasing proportion of treatments in the surgical management of glaucoma between 2015 and 2021.

Elevated urine formaldehyde in elderly patients with primary open angle glaucoma

AIM：To investigate the risk factor of primary open angle glaucoma（POAG）,which is the leading cause of irreversible blindness worldwide.An abnormally high level of endogenous formaldehyde（FA） has recently been found correlated with cell death and neurodegenerative disease,raising the possibility of a putative correlation of abnormal endogenous FA with POAG.· METHODS：Thirty-four elderly patients with POAG and sixteen healthy controls were enrolled.Glaucomatous visual defects were present at both the functional（visual field） and structural[retinal nerve fiber layer（RNFL）thickness]levels.Morning urine samples were obtained and were analyzed by high-performance liquid chromatography（HPLC） to detect the endogenous FA level in a double blind manner.· RESULTS：Patients with POAG（P 〈0.05） had significantly higher urine FA levels.The urine FA level of patients with severe visual field defects[mean deviation（MD）≥12 dB]was significantly（P〈0.001） greater than that of patients with mild to moderate defects（MD〈12 dB）.By optical coherence tomography（OCT）,the superior and inferior RNFL thickness of POAG group was significantly（P〈0.001） thinner than in controls.Furthermore,the superior and inferior thinning of the RNFL was correlated with the elevation of urine FA concentration.CONCLUSION：Endogenous FA level is positively correlated with the neuronal defects of POAG.

Effect of low dose laser cycloplasty on deepening anterior chamber in chronic angle-closure glaucoma

AIM:To describe the outcome of using low-dose laser cycloplasty(LCP)in chronic angle-closure glaucoma(CACG).METHODS:A retrospective case series.Medical charts of CACG patients who underwent LCP in the Eye Hospital of Wenzhou Medical University were reviewed.The main outcomes included intraocular pressure(IOP),the number of glaucoma medication,anterior segment parameters and surgery-related complications.RESULTS:A total of 7 eyes of 7 CACG patients(age 38.9±11.0y)underwent LCP with a mean follow-up of 27.1±13.7mo(range 16-48mo).Following LCP,mean IOP and glaucoma medications decreased from 26.1±6.1 mm Hg with 3.1±1.1 glaucoma medications pre-treatment to 14.9±3.1 mm Hg(P=0.027)with 0.4±1.1 glaucoma medications(P=0.001)at final follow-up.The anterior chamber depth(ACD),angle opening distance500 and trabecular-iris angle increased from 1.65±0.33 mm,0.05 mm(range 0-0.30 mm)and 5.1°(range,0-31.97°)at baseline to 1.98±0.43 mm(P=0.073),0.53 mm(range 0.42-0.91 mm,P=0.015),45.9°(range,40.2°-59.4°),(P=0.015)in the long-term follow-up,respectively.The deepening of ACD and reopening of anterior chamber angle(ACA)was observed in 6 eyes(85.7%).CONCLUSION:LCP is a promising treatment option for patients with CACG via reducing IOP and glaucoma medication without serious complications.In addition,LCP can bring a significant deepening in ACD and reopening of ACA.

Comparison of bevacizumab and ranibizumab in agerelated macular degeneration: a systematic review and meta-analysis

AIMTo compare the effectiveness and safety between bevacizumab and ranibizumab in the treatment of age-related macular degeneration (AMD) through a systematic review and meta-analysis.

鼻咽刷采样法:一种简便可行的鼻咽癌核酸研究的取样方法

背景与目的由于取样困难,用于鼻咽癌(nasopharyngeal carcinoma,NPC)研究的组织标本十分稀缺。既往研究表明,无创鼻咽刷采样法是一种有效的NPC诊断的取样方法。本研究旨在评估鼻咽刷采样法获取鼻咽部核酸进行研究的可行性。方法通过鼻咽刷采集24例健康人和48例NPC患者的鼻咽刷样本。通过内镜活检采集48例NPC和18例鼻咽炎患者的组织。通过定量聚合酶链反应检测两种标本中肿瘤抑制基因(tumor suppressor genes,TSGs)和Epstein-Barr病毒(Epstein-Barr virus,EBV)编码的microRNAs的表达水平及EBV DNA的拷贝数。结果在所检测的6个TSGs中,有2个基因在NPC患者鼻咽刷样本和组织样本中的表达水平显著低于健康/鼻咽炎患者。4个EBV编码的microRNA(包括mir-bart1-5p、mir-bart5、mir-bart6-5p和mir-bart17-5p)在NPC患者鼻咽刷样本和组织样本中的表达水平显著高于健康/鼻咽炎患者(P<0.001)。与健康对照组相比,EBV DNA在NPC患者的鼻咽刷样本(P<0.001)和组织样本(P<0.001)中均显著增加。结论鼻咽刷采样法可以获得足量的肿瘤样品用以病毒核酸分析,包括EBV编码的microRNAs和EBV DNA。对于TSG表达的检测,鼻咽刷采样法尽管可行,但效果不如组织活检法。本研究证实了鼻咽刷采样法是一种适用于NPC核酸研究的取样方法。

Treating epilepsy based on phlegm-turbidity syndrome

Through expounding the theory of phlegm-turbidity and the development of epilepsy,this paper presents the new theoretical basis for the treatment of epilepsy.The authors calculate that phlegm and turbidity are different in the formation and pathogenic effects.Therefore,it is necessary to expound the formation of the phlegm and turbidity.It is also necessary to explain the pathogenesis of the phlegm and turbidity in the epilepsy.Phlegm is caused by the invasion of external evil,emotional disorders,or Qi deficiency and decline,resulting in Qi and blood disorder in the body;the accumulation of phlegm and heat for a long time will lead to the accumulation of turbidity;further with the failure of Qi and fluid circulation,it will lead to brain damage and epileptic seizures.Therefore,the treatment needs to distinguish the severity of phlegm and turbidity,based on which,use different herbs for the treatment of epilepsy.

Nasopharyngeal brushing: a convenient and feasible sampling method for nucleic acid-based nasopharyngeal carcinoma research

Background:Tissue specimens for nasopharyngeal carcinoma(NPC)research are scarce because of sampling dif-ficulties.Previous studies have suggested non-invasive nasopharyngeal brushing as an effective sampling method for NPC diagnosis.The present study aimed to evaluate the feasibility of nasopharyngeal brushing in the acquisition of NPC nucleic acids for research.Methods:Nasopharyngeal brushing samples were acquired from 24 healthy individuals and 48 NPC patients.Tissues from 48 NPC and 18 nasopharyngitis patients were collected by endoscopic biopsy.The expression levels of tumor suppressor genes(TSGs)and Epstein-Barr virus(EBV)-encoded microRNAs as well as EBV DNA copy number were measured by quantitative polymerase chain reaction in both types of samples.Results:Among six TSGs examined,the expression levels of two genes were significantly decreased in nasopharyn-geal brushing and tissue samples from NPC patients as compared with those from healthy/nasopharyngitis indi-viduals.Four EBV-encoded microRNAs,mir-bart1-5p,mir-bart5,mir-bart6-5p,and mir-bart17-5p,were significantly up-regulated in both NPC brushing and tissue samples compared with those from healthy/nasopharyngitis controls(P<0.001).EBV DNA was significantly increased in both nasopharyngeal brushing samples(P<0.001)and tissue sam-ples(P<0.001)from NPC patients in comparison with those from healthy controls.Conclusions:Nasopharyngeal brushing can obtain sufficient tumoral materials for the analysis of viral nucleic acid,including EBV-encoded microRNAs and EBV DNA.For the detection of TSG expression,nasopharyngeal brushings was feasible but inferior to tissue samples.This study confirms nasopharyngeal brushing as an applicable sampling method that can aid in nucleic acid-based NPC research.

Transcriptome-wide association analysis identified candidate susceptibility genes for nasopharyngeal carcinoma

Dear Editor,Nasopharyngeal carcinoma(NPC)is a common malignancy in East and Southeast Asia,especially in South China.The etiology of NPC has been linked to genetic susceptibility,Epstein-Barr virus(EBV)infection,and environmental factors.Accumulated evidence including multiple genome-wide association studies(GWASs)has revealed robust genetic predisposition of NPC.However,GWAS-identified genetic variants collectively account for only 8.2%of NPC heritability[1].The underlying inherited predisposition is largely undetermined.The strongest genetic signal for NPC consistently hits the human leukocyte antigen(HLA)region on 6p21[2].However,the highly polymorphic nature and complicated long-range linkage disequilibrium(LD)in the HLA region particularly obscure the causal variants driving the association.In addition,most genetic variants located in introns or intergenic regions.The causal genes mediating genetic effects on NPC risk have rarely been ascertained by GWAS alone.