Cost of Medical Treatment for Primary Open-Angle Glaucoma in Relation to Patients’ Income and Its Impact on the Prognosis of the Disease, in Bouaké University Hospital

Introduction: Medical treatment for POAG is continuous and lifelong treatment. The aim of this study was to evaluate the relationship between the cost of this treatment and patients’ income and the impact of this relationship on treatment compliance. Materials and Methods: Prospective cross-sectional study with a descriptive aim covering sociodemographic data, average incomes, and direct and indirect costs of treatment of 57 patients followed for POAG during the period from January 1, 2012, to December 31, 2016 (5 years). Results: The patients were aged 25 to 77 years (mean = 54.4 years) with a male predominance (sex ratio = 1.5). Retirees were the most represented (26.32%), followed by workers in the informal sector (14.04%) and housewives (12.28%). Patients who had an annual income less than or equal to 900,000 CFA francs (€1370.83) per year represented 56.14% and those who did not have health coverage represented 57.89%. The treatment was monotherapy (64.91%), dual therapy (31.58%) or triple therapy (3.05%) and the average ratio of “annual cost of treatment to annual income” was 0.56 with for maximum 2.23 and 0.02 as minimum. Patients who considered the cost of treatment unbearable for their income represented 78.95%. Conclusion: Prevention of blindness due to glaucoma requires early detection but also the establishment of health coverage mechanisms to improve compliance with medical treatment. In addition, consideration should be given to the development of glaucoma surgery in our country, the indication of which could be the first intention in certain patients, considering for those patients, the geographical and financial accessibility of medical treatment. .

Epidemiological, Clinical, Therapeutic and Evolutive Profile of Primary Open-Angle Glaucoma in a Cameroonian Population

Background: Sub-Saharan Africa has the highest prevalence of primary open-angle glaucoma (POAG), at 4.2%. The efficacy of medical treatment has been demonstrated and remains one of the treatments of choice for POAG. However, in sub-Saharan Africa, its effectiveness has many challenges, due to multiple factors, including cost and access to care. Thus, the present study aimed to determine the epidemiological, clinical, therapeutic and evolutive profile of primary open-angle glaucoma patients. Methodology: A descriptive cross-sectional study was carried out in two hospitals in western Cameroon. Epidemiological, clinical, therapeutic, and evolutionary data on intraocular pressure at one year after medical treatment were analyzed. SPSS version 23 software was used for statistical analysis, with a significant p-value set at 5%. Results: A total of 201 patients with POAG were included in the study. The population comprised 100 men and 101 women, with a mean age of 54 ± 12 years. At diagnosis, the mean intraocular pressure was 23.9 ± 8.70 mmHg for the right eye and 25.5 ± 9.57 mmHg for the left eye. The mean cup/disc ratio was 0.64 ± 0.2 [0.2-1] and 0.67 ± 0.19 [02-1] in the right and left eyes, respectively. Monotherapy was the most prescribed treatment [59.2%]. After one year of treatment, intraocular pressure was reduced by 15.5% with beta-blockers, 23.66% with prostaglandins, 19.11% with carbonic anhydrase inhibitors, 35, 92% with beta-blockers and carbonic anhydrase inhibitors, 25.92% with beta-blockers and prostaglandins, 48.03% with carbonic anhydrase inhibitors and prostaglandin agonists, and 38.77% with triple therapy. Taking glaucoma severity into account, a significant reduction in intraocular pressure at one year was observed in all participants [p 0.05]. However, the target pressure was obtained in 47%, 20% and 14% of eyes suffering of mild, moderate, and severe grade of POAG respectively. Conclusion: In the present study, there was a significant reduction in intraocular pressure after one year of medical treatment. However, the reduction in intraocular pressure does not allow the target pressure to be reached in severe forms. Thus, alternatives to the medical treatment of POAG should be discussed early in the present context. .

Abnormal Systemic and Ocular Responses to the Valsalva Manoeuvre in Primary Open-Angle Glaucoma:A Case for Autonomic Failure?

Objective This study aimed to examine the association of primary open-angle glaucoma(POAG)with autonomic dysfunction by assessing the differences in systemic and ocular responses to an autonomic provocation test,the Valsalva manoeuvre(VM),between POAG patients and normal subjects.Methods Forty POAG and forty control subjects were subjected to the VM.Systemic and ocular parameters were measured at baseline,phase 2,and phase 4 of the VM(VM2 and VM4),where VM2 and VM4 are sympathetic and parasympathetic nervous activation states,respectively.Heart rate variability was used to assess the autonomic nervous activity,among which the high-frequency component(HF)and the low-frequency(LF)/HF ratio were used as indices of parasympathetic and sympathetic activation,respectively.Results POAG patients demonstrated higher sympathetic activation(LF/HF ratio median:2.17 vs.1.53,P=0.000)than controls at baseline and exhibited attenuated sympathetic and parasympathetic responses(a smaller change in LF/HF and HF values)during the VM than controls.During VM,the intraocular pressure(IOP),mean blood pressure(MAP),mean ocular perfusion pressure(MOPP),and the Schlemm’s canal area(SCAR)increased from baseline to VM2 and then decreased from VM2 to VM4 in both the POAG and control groups(all P<0.05).However,when we compared the changes above,the fluctuations in IOP,MAP,and MOPP were more pronounced in POAG than in controls(all P<0.05),while the changes in amplitudes of SCAR were smaller in POAG(P<0.05).Furthermore,from VM2 to VM4,the choroid thickness(ChT)in the POAG group was significantly decreased,while it was unchanged in normal subjects(P=0.258).A regression analysis showed a significant correlation of the baseline LF/HF with IOP change values(ΔIOP)from baseline to VM2 in POAG(R^(2)=0.147,P=0.014).Conclusion Patients with POAG showed more pronounced fluctuations in IOP,MAP,MOPP and ChT during the VM than controls.These reactions could be associated with autonomic dysfunction in POAG.

Selective laser trabeculoplasty as adjunctive treatment for open-angle glaucoma vs following incisional glaucoma surgery in Chinese eyes

BACKGROUND Selective laser trabeculoplasty(SLT)is a relatively safe and effective therapy in lowering intraocular pressures(IOP)for glaucoma.AIM To study the long-term effects of SLT on IOP and number of glaucoma medications used in Chinese eyes.METHODS This is a retrospective study in which 75 eyes of 70 patients with open-angle glaucoma(OAG,n=36)and eyes with prior glaucoma surgery(PGS,n=39)were included.Changes in mean IOP and number of glaucoma medications used evaluated at 1 d,1 wk,1 mo,3 mo,6 mo,12 mo,and 36 mo after laser treatment.RESULTS All patients(33 male,37 female)were Chinese.The mean age was 44.34±16.14years.Mean pre-SLT IOP was 22.75±2.08 mmHg in OAG and 22.52±2.62 mmHg in PGS.Mean IOP was significantly reduced 1 d,1 wk,1 mo and 3 mo after laser treatment(P<0.05,respectively).Whereas,there were no significant differences between baseline and SLT treated groups at the 6th month both in OAG(P=0.347,P>0.05)and in PGS(P=0.309,P>0.05).Six months after SLT treatment,some patients received retreatment of SLT or were given more topical IOP-lowering medication to control the IOP.By the end of our study,the average IOP decreased to 20.73±1.82 mmHg in OAG and 20.49±1.53 mmHg in PGS groups.The number of glaucoma medications used was significantly reduced until the end of 3 years compared to baseline.CONCLUSION SLT could reduce IOP as adjunctive treatment both in OAG and PGS groups.SLT significantly reduced the number of glaucoma medications used 3-years following treatment in glaucoma patients.

Apoptotic retinal ganglion cell loss is accompanied by complement and cytokine response in theβB1-CTGF primary open-angle glaucoma mouse model

Glaucoma is a multifactorial disease and occurs in many different species.In humans,glaucoma is accounted one of the leading causes for blindness worldwide.Due to glaucoma's complexity,it is still unclear what pathomechanisms may be involved in its development in humans as well as in other species,such as canines.Diagnosis of glaucoma can be delayed because patients often do not notice a visual field loss until approximately30%of retinal ganglion cells(RGCs)are lost(Kerrigan-Baumrind et al.,2000).Although the exact undergoing pathomechanisms of glaucoma disease are not fully understood yet,an increased intraocular pressure(IOP)is related to RGCdeath and is considered the main risk factor.

Prevalence of Open-angle Glaucoma in Southwestern China: the Yongchuan Glaucoma Study

This study examined the prevalence of primary open-angle glaucoma（POAG） among residents aged ≥50 years living in Yongchuan district of Chongqing. Stratified cluster sampling was employed in random selection to estimate the prevalence of glaucoma from April to June, 2005. Twenty-nine villages or neighborhood communities were randomly selected in urban area（Zhongshan Road）, suburban area（Shanjiao Town） and exurban area（Zhutuo Town） of this district. All the respondents underwent detailed ophthalmic examinations. The examinations included questionnaire investigation, visual acuity test, naked-eye examination, measurement of peripheral anterior chamber depth（Van Herrick＇s technique）, detection of intraocluar pressure（IOP） with a Perkins hand-held applanation tonometer（HA-2） and examination of the optic disc by using a 78 diopters（D） lens（including the cup-disc ratio, cup/disc ratio asymmetries, horizontal and vertical diameter, notching and optic disc hemorrhages）. A total of 5938 residents were actually examined, and the response rate was 85.19%. The crude prevalence of POAG was 0.86%（n=51/5938, 95% CI 0.64%–1.11%）. There were 24 males and 27 females in the glaucoma group. The glaucoma prevalence was not significant different in case number between the male and female subjects（P=0.4900）. Furthermore, no association between age or schooling and POAG was noted（P=0.8030, 0.0734）. Out of 51 subjects with POAG, unilateral glaucoma-related blindness occurred in 38 subjects（74.5%） and bilateral glaucoma-related blindness was found in 7 subjects（13.7%）. This study exhibited that the prevalence of POAG was 0.86% among residents aged ≥50 years living in Yongchuan District of Chongqing. The vision loss caused by POAG in this population was obviously higher than that previously reported in other studies. Glaucoma management, detection of affected persons and handling of the burden of glaucoma should be the priorities of the agenda of local health authorities of Western China.

Coinheritance of OLFM2 and SIX6 variants in a Chinese family with juvenile-onset primary open-angle glaucoma: A case report

BACKGROUND Juvenile-onset primary open-angle glaucoma(JOAG),characterized by severe elevation of intraocular pressure and optic neuropathy prior to the age of 40,is a rare subtype of primary open-angle glaucoma.Several genetic mutations have been associated with JOAG.CASE SUMMARY The proband patient was a young male,diagnosed with primary open-angle glaucoma at the age of 27.The patient and his unaffected parents who have been excluded from classic genetic mutations for primary open-angle glaucoma were included to explore for other possible genetic variants through whole genome sequencing and bioinformatics analysis.In this trio,we found two heterozygous variants inherited from the parents in the proband:c.281G>A,p.Arg94His in OLFM2 and c.177C>G,p.Ile59Met in SIX6.Both genetic mutations are predicted through bioinformatics analysis to replace evolutionary conserved amino acids,therefore rendering a pathogenic effect on proteins.In contrast,very low frequencies for these genetic mutations were recorded in most common control databases.CONCLUSION This is the first report on coinherited mutations of OLFM2 and SIX6 in a JOAG family,which shows the complexity of JOAG inheritance.Large-scale clinical screening and molecular functional investigations on these coinherited mutations are imperative to improve our understanding of the development of JOAG.

Supraciliary microstenting with phacoemulsification in patients with open-angle glaucoma and cataracts

Elevated intraocular pressure(IOP)is a major risk factor for the development or progression of glaucoma.Lowering IOP is the only proven therapeutic approach to the management of glaucoma.IOP can be lowered by medication,laser treatment or surgery(1).Generally,instillation of IOP-

SEQUENTIAL INTRAOCULAR PRESSURE MEASUREMENTS IN SUSPECTED OPEN-ANGLE GLAUCOMA

Objective To evaluate the variations of intraocular pressure （lOP） in suspected open-angle glaucoma （OAG） patients. Methods The variations of lOP were measured in 216 eyes of suspected OAG patients at 4-hour intervals for 48 h. Based on the results of the serial lOP measurements, optic disc changed and visual field defected, the patients were diagnosed as primary OAG （ POAG ）, normal tension glaucoma （NTG）, ocular hypertension （ OHT） , or physiologic cup （PC）. Results After the serial lOP measurements, 16. 7% of the suspected OAG patients were diagnosed as POAG, 32. 4% as NTG, 24. 5% as OHT, and 26. 4% as PC. The highest percentages of the POAG group had peak lOP at 8 AM （19. 4% ） and their trough lOP at 10 PM （27. 8% ） ; the NTG group had peak lOP at 12 AM （18. 6% ） and their trough lOP at 12 PM （22. 9% ） ; the OHT group had peak lOP at 4 AM （22. 6% ） and their trough lOP at 10 PM （26. 4% ） ; and the PC group had peak lOP at 4 AM （ 21. 1% ） and their trough lOP at 12 PM （ 21. 1% ）. The percentages of peak lOP outside clinic （ 8 AM - 4 PM） in the POAG, NTG, OHT and PC groups were 55. 6%, 50. 0%, 58. 4% and 45. 7%, respectively. The mean magnitude of variance was 5. 1 - 6. 7 mmHg in those suspected OAG patients. There was a strong positive correlation in lOP between both eyes at each time point of measurement and the variation curves of the right and left eyes had parallel profiles in those suspected OAG patients. Conclusion Serial measurement of lOP is still needed, in order not to miss the peak and the trough lOP readings in suspected OAG patients, which helps in better management of glaucoma.

Changes in corneal endothelial cell density in patients with primary open-angle glaucoma

BACKGROUND Glaucoma is a group of diseases characterized by a specific pattern of optic nerve neuropathy and retinopathy.Increasing evidence demonstrates glaucoma associated corneal endothelium loss.Direct-compression mechanism due to elevated intraocular pressure(IOP),cell toxicity after long term exposure to preservatives and glaucoma surgery have been reported to be the possible mechanism.Herein,we compare the specular endothelial microscopy in primary open-angle glaucoma(POAG)patients and healthy controls of the same age group to observe the corneal endothelium changes and the correlations to the mean IOP in a Chinese case control study.AIM To investigate corneal endothelial cell density in Chinese patients with POAG.METHODS A case control study was performed on 60 eyes of 60 patients with POAG.Exclusion criteria included history of corneal diseases,intraocular diseases,contact lens use,ocular trauma or surgery(including intraocular surgery and laser treatment),congenital abnormalities or systemic diseases such as diabetes.Intraocular pressure was measured using Goldmann tonometry.Indirect specular microscopy(TOPCON SP-2000P)was performed on central corneas and endothelial images were acquired.Endothelial cell density,area and cell counts were analyzed.RESULTS Endothelial cell density was 2959±236 cells/mm2 in healthy controls and 2757±262 cells/mm2 in patients with POAG.The POAG eyes had significantly lower endothelial cell density compared to healthy control eyes(P<0.001).In the POAG group,endothelial cell density was 2686±233 cells/mm2 in the patients receiving medication and 2856±272 cells/mm2 in the untreated subgroup.The eyes receiving medication had significantly lower endothelial cell density compared to untreated eyes.There was a negative correlation between cell density and mean IOP(r=-0.286,P=0.004),positive correlation between the average cell area and mean IOP(r=0.228,P=0.022),maximum cell area and mean IOP(r=0.218,P=0.029)and minimum cell area and mean IOP(r=0.290,P=0.003).The percentage of hexagonal cells was not correlated with mean IOP.CONCLUSION Patients with POAG have lower corneal endothelial cell density than healthy controls of the same age.This may be attributed to mechanical damage from elevated IOP and toxicity of glaucoma medications.

Combined phacoemulsification and anterior vitrectomy in a case of anterior megalophthalmos with open-angle glaucoma and high myopia

Dear Editor,I am Dr.Cai-Xuan Huang,from the Eye Center,Renmin Hospital of Wuhan University,Hubei Province,China.I write to present a case report of bilateral anterior megalophthalmos with open-angle glaucoma,which was treated by combined phacoemulsification and anterior vitrectomy.

Decorin treatment for reversing trabecular meshwork fibrosis in open-angle glaucoma

In this perspective,we discuss the use of an anti-fibrotic agent Decorin to treat established fibrosis associated with glaucoma originally published by Hill et al.（2015）.Glaucoma describes a group of progressive optic neuropathies that have the potential to cause irreversible blindness.

Optical Coherence Tomography Parameters in Preperimetric Open-Angle Glaucoma

Purpose: To evaluate the measurements of the peripapillary retinal neurofiber layers (RNFL) and the ganglion cells complex (GCC) obtained by Optical Coherence Tomography (OCT) in eyes with preperimetric open-angle glaucoma. Methods: One hundred and forty eyes of 75 patients (21 male and 54 female), 80 eyes with preperimetric glaucoma (PPG) (45 patients) and 60 normal eyes (30 subjects) were included in this study. Automated visual field examination was done to all participants using Humphrey field analyzer, program 30-2. The GCC thickness and peripapillary RNFL thickness were measured using RTVue-100 (Optivue, Inc., Fremont, CA). The areas under ROC (receiver operating characteristic)—curves (AUCs) were defined for all examined GCC and RNFL parameters. Results: GCC of the eyes with PPG was significantly thinner than GCC of the normal eyes: (89.58 vs 97.82 microns, P < 0.001). There was no significant difference between upper and lower GCC halves in both study groups. We found a reduction of RNFL thickness in glaucomatous eyes (P < 0.001) compared with normals. AUCs for GCC parameters in eyes with PPG were larger than AUCs for RNFL parameters. Conclusion: Our study showed that the peripapillary RNFL and GCC thickness are lower in preperimetric glaucoma than in normal eyes. Despite the fact that GCC measurements (especially GLV) show better AUC than peripapillary measurements, we suggest that two scans (GCC and ONH) put together are superior in detecting early structural glaucomatous damage. Several diagnostic parameters should be considered in the clinical diagnosis of preperimetric glaucoma.

Incidence of Primary Open-Angle Glaucoma at the Flamboyants Communal Medical Center of Conakry, Guinea

Background: Primary Open-Angle Glaucoma (POAG) is a chronic, progressive optic neuropathy of multifactorial origin defined by alterations in the visual field, progressive loss of optic nerve fibers and ganglion cells, and an open iridocorneal angle in gonioscopy. It is the world’s leading cause of irreversible blindness. There is no epidemiological study in Guinea that allows us to locate the real level of the problem. The objective of this study is to determine the hospital incidence of POAG at the Centre Médical Communal (CMC) in the Flamboyants. Patients and Method: This was a descriptive cross-sectional study with a prospective collection for one year, from April 1, 2020 to March 31, 2021, in patients aged at least 40 years, received in consultation at the CMC in the Flamboyants. The diagnostic criterion for a new case of glaucoma was the presence in a patient of the following two signs: (excavation of the optical disc C/D ≥ 0.5 and alteration of the visual field) with an open angle at least stage 4 of the Shaffer and Etienne classification associated or not with ocular hypertonia and having never received anti glaucoma treatment. We described variables related to sociodemographic characteristics, visual acuity, intraocular pressures, papillary excavations, and visual field surveys. Informed consent from patients was sought and obtained. The confidentiality of the files was guaranteed. Results: 68 new cases of POAG were diagnosed out of 3220 consultations, an incidence rate of 2.11%. The average age was 58.2 years (10.64 with a male predominance of 63.23%. A family history of glaucoma was present in 11.36% of cases. Visual acuity was poor Conclusion: This study has shown us that POAG in our environment is relatively common, early onset, and rapidly evolving. The implementation of a rapid and reliable screening strategy by the Eye Health Program will make it possible to manage glaucoma from the earliest stages.

Socio-Economic Impacts of Primary Open-Angle Glaucoma in Rural Environment in Mali

Primary open-angle glaucoma (POAG) is an optic neuropathy that affects the patient’s quality of life. The present study aims to write the socio-economic factors influencing the management of glaucomatous patients in rural areas. This was a retrospective, descriptive cross-sectional study, carried out from October 19 to 31, 2017 in a rural town. The variables studied were age, sex, occupation, level of knowledge about the disease and its treatment, average monthly income, accessibility of eye care service, health insurance membership, degree of severity of the disease. The frequency of POAG was 5.68%. The average age of the patients was 52 years old with extremes ranging from 25 to 73 years old;the female sex was the most represented with 19 cases out of 36 or 52.77%. 66.67% of our patients were at their first ophthalmological consultations. Health insurance coverage was 2.78%. The average monthly income was 10,000 to 25,000 FCFA in 58.33%. More than half of our glaucomatous patients, 63.89%, think they are affected by their disease. 80% of patients are unaware that they have eye disease. Many lost vision in one or both eyes and were unaware of the disease affecting their eyes. Accessibility to health services and their costs seem to be a factor, in addition to illiteracy.

Changes in peripapillary retinal nerve fiber layer thickness in patients with primary open-angle glaucoma after deep sclerectomy

AIM： To assess changes in peripapillary retinal nerve fiber layer （RNFL） thickness and visual field （VF） in patients with glaucoma after reduction of intraocular pressure （IOP）. METHODS： Thirty-five consecutive patients with bilat-eral high tension glaucoma were included in the study. Thirty-five eyes underwent monocular deep sclerectomy （surgery group） and the medically treated fellow eyes served as controls （control group）. Quantitative analyses of the peripapillary RNFL thickness by optical coherence tomography （OCT） and global VF indices by automated perimetry were performed before surgery and six months after surgery in both eyes. The changes in RNFL thickness overall and by quadrant were evalu-ated and studied with respect to age, best-corrected visual acuity （BCVA）, preoperative global VF indices, postoperative IOP changes, and postoperative changes in global VF indices. Changes observed in RNFL thickness and VF indices were compared between eyes after surgery and fellow eyes. RESULTS： Six months after surgery, the overall IOP decreased from a baseline mean of 24.5 ± 3.2 mmHg to 11.5 ± 2.7 mmHg （P 〈 0.001） at the time of OCT testing. A signifcant increase in the overall mean RNFL thickness was observed after surgery （P 〈 0.001）. The preoperative VF mean deviation was significantly cor-related with a postoperative increase in the RNFL thick-ness （P 〈 0.075）. No correlation was found between RNFL thickness changes and age, BCVA, or changes in the global VF indices. There was no significant difference between eyes with an IOP reduction of more than 50% and those with a reduction in IOP less than 30% （ P = 0.312）.CONCLUSION： A signifcant increase in the peripapil-lary RNFL thickness was associated with IOP reduction by glaucoma filtration surgery as measured by OCT.

A BLIND RANDOMIZED CROSS -OVER TRIAL COMPARING BETAXOLOL WITH TIMOLOL IN OPEN-ANGLE GLAUCOMA AND OCULAR HYPERTENSION

Purpose: To compare the short-term efficacy and side effects of betaxolol and timoloi in treatment of primary open angle glaucoma or ocular hypertension. Methods: Fourteen patients with newly diagnosed early primary open angle glaucoma or ocular hypertension were included.Each patient received 0.5% timoloi and 0.5% betaxolol twice daily for four weeks in two phases. Between two courses of treatment there was four weeks wash out period. At the end of study the effect of these two drugs on intraocular pressure, mean arterial blood pressure,pulse rate,basic tear secretion and ocular symptoms were evaluated and statistically analyzed,using wilcoxon and chi-squar test.RESULTS:The study was performed on fourteen patients with baseline IOP of 26.7 ±1.5 mmHg.After four weeks treatmem,timoiol and betax-olol reduced IOP by 7.8±1.2mmHg or 29% and 6.1±1.3mmHg or 23%, respectively (P<0.001). The difference between two groups was significant(P<0.001). Mean arterial blood pressure was reduced with betaxolol and

Surgical outcomes of XEN45 implantation,trabeculectomy vs.penetrating canaloplasty in open-angle glaucoma:A non-randomized comparative study

To the Editor:Glaucoma is a leading cause of irreversible blindness worldwide.[1]Trabeculectomy with mitomycin C(MMC)has been the standard surgical intervention for reducing intraocular pressure(IOP)and slow down the progression of glaucoma.[2]However,some serious complications with devastating consequences can occur after trabeculectomy,such as bleb-related infections,suprachoroidal hemorrhage,vitreous hemorrhage,and malignant glaucoma.Over the last decade,many novel ophthalmic surgical devices have been used in glaucoma.The XEN45 microstent(Allergan,Dublin,CA,USA)is a hydrophilic cross-linked porcine gelatin stent.It is implanted ab-interno.

Identification and validation of key biomarkers and potential therapeutic targets for primary open-angle glaucoma

Primary open-angle glaucoma(POAG)is a prevalent cause of blindness worldwide,resulting in degeneration of retinal ganglion cells and permanent damage to the optic nerve.However,the underlying pathogenetic mechanisms of POAG are currently indistinct,and there has been no effective nonsurgical treatment regimen.The objective of this study is to identify novel biomarkers and potential therapeutic targets for POAG.The mRNA expression microarray datasets GSE27276 and GSE138125,as well as the single-cell high-throughput RNA sequencing(sc RNA-seq)dataset GSE148371 were utilized to screen POAGrelated differentially expressed genes(DEGs).Functional enrichment analyses,protein-protein interaction(PPI)analysis,and weighted gene co-expression network analysis(WGCNA)of the DEGs were performed.Subsequently,the hub genes were validated at a single-cell level,where trabecular cells were annotated,and the mRNA expression levels of target genes in different cell clusters were analyzed.Immunofluorescence and quantitative real-time PCR(q PCR)were performed for further validation.DEGs analysis identified 43 downregulated and 32 upregulated genes in POAG,which were mainly enriched in immune-related pathways,oxidative stress,and endoplasmic reticulum(ER)stress.PPI networks showed that FN1 and DUSP1 were the central hub nodes,while GPX3 and VAV3 were screened out as hub genes through WGCNA and subsequently validated by q PCR.Finally,FN1,GPX3,and VAV3 were determined to be pivotal core genes via single-cell validation.The relevant biomarkers involved in the pathogenesis of POAG,may serve as potential therapeutic targets.Further studies are necessary to unveil the mechanisms underlying the expression variations of these genes in POAG.

Long-term outcomes of two first-generation trabecular micro-bypass stents (iStent) with phacoemulsification in primary open-angle glaucoma: eight-year results

Background:The short-and medium-term outcomes of iStent have been extensively studied;however,only few studies have investigated its long-term outcomes.Here,we assessed the long-term efficacy and safety of two iStents with concomitant cataract surgery in glaucomatous eyes while also evaluating measures of disease stability using vis-ual field and optical coherence tomography(OCT)of the optic nerve and the macula throughout eight years of follow-up.Methods:This longitudinal,single-center consecutive case series included glaucomatous eyes that underwent implantation of two first-generation trabecular micro-bypass stents(iStent)with concomitant cataract surgery.Eight-year efficacy outcomes included mean intraocular pressure(IOP)and medications,as well as surgical success.Eight-year safety outcomes included best-corrected visual acuity(BCVA),visual field mean deviation(VF-MD),cup-to-disc ratio(CDR),retinal nerve fiber layer(RNFL)thickness,ganglion cell-inner plexiform layer(GC-IPL)thickness,and adverse events.Results:A total of 62 eyes with primary open-angle glaucoma(POAG)were included.At eight years postoperative,IOP reduced by 26%from 19.2±3.9 mmHg preoperatively to 14.2±2.4 mmHg(P<0.001),91.1%of eyes achieved IOP≤18 mmHg(vs.51.6%preoperatively),69.6%of eyes achieved IOP≤15 mmHg(vs.14.5%preoperatively),and 25%of eyes achieved 1OP≤12 mmHg(vs.1.6%preoperatively).Medication use decreased by 17.9%from 2.8±1.1 preoperatively to 2.3±1.2(P=0.018).Surgical success rate was 90%,as six eyes underwent subsequent glaucoma surgeries.Safety measures of BCVA,CDR,RNFL thickness and GC-IPL thickness remained stable through eight years postoperative.VF-MD remained stable until postoperative year five and subsequently progressed according to the natural history of glaucomatous disease.Conclusions:Implantation of two iStents with concomitant cataract surgery is an effective and safe treatment option for surgery-naive POAG eyes,evidenced by significant IOP and medication reductions,reasonable surgical suc-cess,and favorable safety outcomes,throughout the eight-year follow-up.Our data additionally support the efficacy of this combined procedure in stabilizing or slowing disease progression.