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.

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.

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.

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.

Clinical relevance of the glucocorticoid receptor gene polymorphisms in glucocorticoid-induced ocular hypertension and primary open angle glaucoma

AIM: To avoid the side effects of ocular hypertension of glucocorticoid(GC) usage in eye, we must identify susceptible individuals, which exists in about one-third of all population. Further, the majority of all primary open angle glaucoma(POAG) patients show this phenotype.Glucocorticoid receptor(GR) regulates C responsiveness in trabecular meshwork(TM) cells. In this study, single nucleotide polymorphism(SNP) genotyping was used to determine whether there are differences in the Bcl I(rs41423247) and N363S(rs6195) polymorphisms of the GR gene in healthy and POAG patients, and glucocorticoid-induced ocular hypertension(GIOH)populations.METHODS: Three hundred and twenty-seven unrelated Chinese adults, including 111 normal controls, 117 GIOH subjects and 99 POAG patients, were recruited. DNA samples were prepared and the Bcl I and N363 S polymorphisms were screened using real-time polymerase chain reaction(RT-PCR)-restriction fragment length polymorphism(RFLP) analysis. Frequencies of the Bcl I and N363 S polymorphisms were determined and compared using Fisher’s exact test and the Chi-squared test.RESULTS: Only the Bcl I polymorphism was identified in the Chinese Han population. The frequency of the G allele was 21.6 % in normal controls, 18.3% in GIOH patients, and 13.64% in the POAG patients. There was no significant difference in polymorphism or allele frequency in the 3 groups. Furthermore, no N363 S polymorphism was found in the study subjects.CONCLUSION: The Bcl I polymorphisms in GR gene had no association with GIOH and POAG patients, and N363 S polymorphism might not exist in the Chinese Han population. Therefore, the Bcl I polymorphism might not be responsible for the development of GC-induced ocular hypertension or POAG.

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.

Retinal nerve fiber layer in primary open-angle glaucoma with high myopia determined by optical coherence tomography and scanning laser polarimetry

Background Fundus changes associated with high myopia （HM） may mask those associated with primary open-angle glaucoma （POAG）. This study aim to determine the characteristics of RNFL thickness changes in patients with both POAG and HM and compare these to changes in patients with only HM. The diagnostic capabilities of both OCT and GDxVCC in this subset of patients are also evaluated. Methods Twenty-two eyes with POAG and HM （spherical equivalent （SE） between -6.0 and -12.0 D） were evaluated, and 22 eyes with HM were used for comparison. Characteristic retinal nerve fiber layer （RNFL） thickness profiles in patients with POAG and HM were examined using optical coherence tomography （OCT） and scanning laser polarimetry with variable corneal compensation （GDxVCC）, and the diagnostic capabilities of these imaging modalities were compared. RNFL parameters evaluated included superior average （Savg-GDx）, inferior average （lavg-GDx）, temporal-superior-nasal- inferior-temporal （TSNIT） average, and nerve fiber indicator （NFI） on GDxVCC and superior average （Savg-OCT）, inferior average （lavg-OCT）, nasal average （Navg-OCT）, temporal average （Tavg-OCT）, and average thickness （AvgThick-OCT） on OCT （fast RNFL scan）. Visual field testing was performed and defects were evaluated using mean defect （MD） and pattern standard deviation （PSD）. Results The RNFL parameters （P 〈0.05） significantly different between groups included Savg-GDx, lavg-GDx, TSNIT average, NFI, Savg-OCT, lavg-OCT, Tavg-OCT, and AvgThick-OCT. Significant correlations existed between TSNIT average and AvgThick-OCT （r=0.778）, TSNIT average and MD （r=0.749）, AvgThick-OCT and MD （r=0.647）, TSNIT average and PSD （r=-0.756）, and AvgThick-OCT and PSD （r=-0.784）. The area under the receiver operating characteristic curve （AUROC） values of TSNIT average, Savg-GDx, lavg-GDx, NFI, Savg-OCT, lavg-OCT, Navg-OCT, Tavg-OCT, and AvgThick-OCT were 0.947, 0.962, 0.973, 0.994, 0.909, 0.917, 0.511, 0.906, and 0.913, respectively. The NFI AUROC was the highest value. Conclusions RNFL thickness was significantly lower in all but the nasal quadrant in patients with POAG and HM, compared to patients with only HM. Measurements with OCT and GDxVCC were well-correlated, and both modalities detected RNFL thickness chanaes. However. GDxVCC was better than OCT in detectina POAG in HM Datients.

Identification of Mutations in Myocilin and Beta-1,4-galactosyltransferase 3 Genes in a Chinese Family with Primary Open-angle Glaucoma

Background： Glaucoma is a major cause of irreversible blindness worldwide. There is evidence showing that a subset of the disease is genetically determined. In this study, we screened for mutations in chromosome lq-linked open-angle glaucoma （GLC1A） in a Chinese family with primary open-angle glaucoma （POAG）. Methods： A total of 23 members from five generations of a family were enrolled and underwent thorough ophthalmologic examinations. In addition, 200 unrelated healthy Chinese controls were also recruited as normal control. GLC1A gene was amplified by polymerase chain reaction, and DNA sequencing was performed to screen for mutations. Results： Six members were diagnosed as POAG, with severe clinical manifestations, and history of high intraocular pressures. The mean age of disease onset was 26.3 years. However, the others were asymptomatic. In six affected and three asymptomatic members, gene sequencing revealed a mutation c.C1456T in exon 3 of myocilin gene （MYOC）. Furthermore, we also identified a novel mutation c.G322A in beta- 1,4-galactosyltransferase 3 （B4GALT3） gene in all six affected and three asymptomatic members, which was not reported previously in POAG patients. The two newly identified variants were absent in other family members as well as controls. Conclusion： The mutations c.1456C〈T （p.L486F） in MYOC and c.322G〈A （p.V1081） in B4GALT3 are likely responsible for the pathogenesis of POAG in this family.

Comparison of corneal biomechanics among primary open-angle glaucoma with normal tension or hypertension and controls

Background:Normal tension glaucoma(NTG)is a less pressure-dependent type of glaucoma with characteristic optic neuropathy.Recently,the biomechanical mechanism has been thought to account for glaucomatous optic neuropathy to some degree.We intended to compare dynamic corneal response parameters(DCRs)among patients with primary open-angle glaucoma with normal tension or hypertension and controls.The correlations between DCRs and known risk factors for glaucoma were also analyzed.Methods:In this cross-sectional study,49 NTG subjects,45 hypertension glaucoma(HTG)subjects,and 50 control subjects were enrolled.We compared the differences in DCRs using corneal visualization Scheimpflug technology among the NTG,HTG,and control groups.We also analyzed the correlations between DCRs and known risk factors for glaucoma(eg,central corneal thickness[CCT],intraocular pressure[IOP],etc).Results:The maximum inverse concave radius(NTG:0.18[0.17,0.20]mm-1;control:0.17[0.16,0.18]mm-1;P=0.033),deformation amplitude ratio of 2 mm(DAR 2 mm,NTG:4.87[4.33,5.39];control:4.37[4.07,4.88];P<0.001),and DAR 1 mm(NTG:1.62[1.58,1.65];control:1.58[1.54,1.61];P<0.001)were significantly higher in NTG than in the controls.The integrated radius(IR,NTG:8.40±1.07 mm-1;HTG:7.64±1.31 mm-1;P=0.026)and DAR 2 mm(NTG:4.87[4.33,5.39];HTG:4.44[4.12,5.02];P<0.007)were significantly higher,whereas the stiffness parameter at the first applanation(SP-A1,NTG:91.23[77.45,107.45];HTG:102.36[85.77,125.12];P=0.007)was lower in NTG than in HTG.There were no significant differences in the DCRs between HTG and control groups(P>0.05).In the univariate and multivariate analyses,some of the DCRs,such as IR,were negatively correlated with CCT and IOP,whereas SP-A1 was positively correlated with CCT and IOP.Conclusions:The cornea was more deformable in NTG than in HTG or controls.There were no significant differences in corneal deformability between HTG and controls.The cornea was more deformable with the thinner cornea and lower IOP.

Ethylenediaminetetraacetic Acid Chelation for Band Keratopathy before Ab Interno Glaucoma Surgery

An 87-year-old woman with primary open-angle glaucoma presented to our hospital. Although the combined cataract and minimally invasive glaucoma surgeries (MIGS) were an appropriate surgical option, the presence of band keratopathy made it difficult to perform ab interno glaucoma surgery in her right eye (OD);therefore, the corneal opacity was removed using ethylenediaminetetraacetic acid (EDTA) chelation procedure. One month after chelation, microhook ab interno trabeculotomy and cataract surgery were performed successfully. Clear intraoperative visualization of the angle structures is critical for the success of these MIGS procedures. In glaucomatous eyes that require MIGS, EDTA chelation is a good neoadjuvant therapy for coexisting band keratopathy.

In vivo confocal microscopy:qualitative investigation of the conjunctival and corneal surface in open-angle glaucomatous patients undergoing the XEN-Gel implant,trabeculectomy or medical therapy

Purpose:Assessing the quality of the ocular surface by in vivo scanning laser confocal microscopy(IVCM)in primary open-angle glaucoma(POAG)patients treated by XEN 45 Gel Stent,medical therapy and trabeculectomy.Methods:Retrospective,single-center,single-masked,comparative study including 60 eyes of 30 patients(mean age 61.16±10 years)affected by POAG.Eyes were divided into 3 groups:Group 1 eyes underwent the XEN 45 Gel Stent procedure,Group 2 eyes^were under medical therapy,Group 3 eyes were surgically treated by trabeculectomy.All patients underwent HRTII IVCM analysis of cornea,limbus,conjunctiva,sub-tenionian space and sclera.Results:The XEN 45 Gel Stent,if properly positioned in the sub-conjunctival space preserves goblet cells and limits ocular surface inflammation.Regular corneal epithelial cells with microcysts,and normo-reflective sub-epithelial nerve plexus are documented by IVCM.In sub Tenon's implants an alternative lamellar intra-scleral filtration is detectable.Combined surgical procedures show a noticeable number of inflammatory cells with rare microcysts.Post-trabeculectomy inflammatory reaction is more evident than XEN 45 Gel Stent associated surgical procedures,but less than medical therapy where a conspicuous presence of Langerhans cells,peri-neural infiltrates,marked loss of goblet cells and fibrosis is visible.Conclusion:Ocular surface inflammation was more notable in topical therapy than after trabeculectomy,which itself causes more inflammation than XEN Gel Stents.

糖基化终末产物对体外培养牛眼小梁细胞氧化应激及凋亡的影响

目的通过观察糖基化终末产物(advanced glycation end products,AGE)对体外培养牛眼小梁细胞凋亡的影响,研究AGE与原发性开角型青光眼(primary open angle glaucoma,POAG)之间的关系,进一步探讨其发病机制。方法体外培养牛眼小梁细胞,通过形态学观察和神经元特异性烯醇化酶染色对培养的细胞进行鉴定。将第3代小梁细胞接种于6孔培养板,在培养基中加入不同浓度(0μg·mL-1、50μg·mL-1、100μg·mL-1、200μg·mL-1)的AGE-BSA培养96 h。终浓度(200μg·mL-1)的AGE-BSA培养液处理细胞不同时间(48 h、72 h、96h)。应用流式细胞仪检测小梁细胞凋亡率;活性氧荧光探针2’,7’-二氯荧光黄双乙酸盐检测细胞内活性氧(ROS)水平。结果 50μg·mL-1、100μg·mL-1、200μg·mL-1AGE-BSA作用96h后细胞凋亡率分别为(5.60±0.25)%、(9.57±0.08)%、(17.68±0.21)%,与对照组(0μg·mL-1AGE-BSA)细胞凋亡率(4.45±0.12)%相比均明显增高,且差异均有统计学意义(均为P<0.05);200μg·mL-1AGE-BSA作用细胞48 h、72 h、96 h后凋亡率分别为(10.51±0.28)%、(13.47±0.42)%、(17.68±0.21)%,与对照组相比也均明显增高,差异均有统计学意义(均为P<0.05)。与对照组比较,AGE-BSA处理后细胞内ROS水平显著提高,差异有统计学意义(P<0.05),BSA组差异无统计学意义(P>0.05)。结论在体外培养的条件下,AGE可能通过刺激牛眼小梁细胞产生大量ROS介导小梁细胞凋亡。

两种不同方法治疗残余性晚期原发性开角型青光眼的疗效比较

目的比较选择性激光小梁成形术(SLT)和曲伏前列腺素滴眼液治疗残余性晚期原发性开角型青光眼(POAG)的效果。方法采用非随机对照研究,将30例30眼患者分为SLT组15例(接受SLT治疗)和药物组15例(接受0. 004%曲伏前列腺素滴眼液治疗),观察两组治疗前、治疗后1 d、1周、1个月、3个月及6个月眼压变化情况。结果两组治疗前眼压比较差异无统计学意义(P> 0. 05),两组治疗后各个时间点的眼压均较术前下降,差异有统计学意义(P <0. 05)。治疗后3个月,两组眼压比差异无统计学意义(P>0. 05),其余时间点,两组眼压比较差异均有统计学意义(P <0. 05)。与治疗前的基线眼压相比,治疗后1 d,SLT组眼压下降的幅度大于药物组,其余各时间点药物组眼压下降的幅度均大于SLT组。SLT组患者治疗后眼压的波动大于药物组。两组并发症发生率比较差异无统计学意义(P> 0. 05)。结论 SLT可有效降低残余性晚期POAG患者的眼压,但降压效果及稳定性逊于曲伏前列腺素滴眼液。

原发性开角型青光眼患者脑磁共振成像研究进展

青光眼是全球首位不可逆致盲性眼病,最常见类型为原发性开角型青光眼(primary open-angle glaucoma, POAG),由于发病机制不清,因此治疗效果不佳。近年来,包含多模态MRI在内的神经影像学研究表明:POAG是一种神经退行性病变,视觉传导通路及视路以外脑区的结构、功能、血流灌注及代谢等都发生了广泛改变,且与POAG患者病情严重程度相关。未来更加需要多中心大样本量前瞻性队列研究,采用机器学习、深度学习方法将多模态MRI数据融合,进一步研究中枢神经系统改变之间的相互关系及其与视网膜改变和视觉障碍的相关性,为早期诊断和治疗提供更加明确的依据。本文系统综述了POAG患者脑MRI研究进展和价值,同时提出存在的问题与未来研究思路,旨在为该领域研究提供参考。

Ex-PRESS implantation versus trabeculectomy in Chinese patients with POAG:fellow eye pilot study

AIM： To compare the outcomes of Ex-PRESS implantation in one eye versus trabeculectomy with mitomycin C in the fellow eye in Chinese patients with primary open-angle glaucoma （POAG）. METHODS： This was a prospective, non-randomized comparative study. Forty-eight eyes of 24 patients with bilateral POAG necessitating surgery were included and underwent Ex-PRESS implantation under the scleral flap in one eye and trabeculectomy in the other eye according to patients’ choice. Primary outcome measures included mean intraocular pressure （IOP） and success rate. Secondary outcome measures were aqueous flare, postoperative medication use, visual acuity, and incidence of complications.RESULTS： All 24 patients finished a 1-year follow-up. Both groups maintained significant reductions in IOP after surgery throughout the follow-up period. At any point in time, the IOP of the two groups did not differ significantly. The Kaplan-Meier survival curve analysis showed no significant differences in success between the two groups （P=0.289）. The mean number of anti-glaucoma medicines and visual acuity in both groups were not significantly different. Eyes with Ex-PRESS implantation had lower aqueous flare values on days 1 and 3 （both P〈0.05）. Instances of early postoperative hypotony and choroidal effusion were significantly fewer in frequency after Ex-PRESS implantation under the scleral flap compared with those after trabeculectomy （P〈0.001）. CONCLUSION： Ex-PRESS is comparable to trabeculectomy in terms of IOP, success rate, number of glaucoma medications used, and visual acuity. However, Ex-PRESS resulted in fewer cases of inflammation and a lower rate of complications.

Effect of CD44 Suppression by Antisense Oligonucleotide on Attachment of Human Trabecular Meshwork Cells to HA

The effects of suppression of CD44 by CD44-specific antisense oligonucleotide on attachment of human trabecular meshwork cells to hyaluronic acid (HA) were observed and the possible relationship between CD44 and primary open-angle glaucoma (POAG) investigated. CD44-specific antisense oligonucleotide was delivered with cationic lipid to cultured human trabecular meshwork cells. The expression of CD44 suppressed by CD44-specific antisense oligonucleotide was detected by RT-PCR and Western blotting. The effect of CD44 suppression by specific antisense oligonucleotide on attachment of trabecular meshwork cells to HA was measured by MTT assay. Results showed that expression of CD44 was suppressed by CD44-specific antisense oligonucleotide. Antisense oligonucleotide also suppressed the adhesion of human trabecular meshwork cells to HA in a concentration dependent manner. It was concluded that attachment of human trabecular meshwork cells to HA was decreased when CD44 was suppressed by specific antisense oligonucleotide. CD44 might play a role in pathogenesis of POAG by affecting the adhesion of trabecular meshwork cells to HA.

黏弹剂施氏管扩张切开术治疗青光眼临床观察

目的评价黏弹剂施氏管扩张切开术（以下简称黏管切开术）治疗晚期原发性开角型青光眼的临床疗效。方法晚期原发性开角型青光眼68例（68只眼），分为黏管切开术（A组）33例．复合小梁切除术（B组）35例。比较两组术后的眼压、视力及并发症。结果两组眼压变化趋势差异无统计学意义。两组手术前、后视力差异无统计学意义。并发症方面：A组术后除2例发 生轻度前房炎症反应（6．0％），1例发生前房积血（3．0％）外，无其他并发症；而B组，术后浅前房7只眼（20．0％），所有患者均有轻度前房炎症反应，睫状体或脉络膜脱离3只眼（8．5％），前房积血2只眼（5．7％），内内障3只眼（8．5％）。手术成功率：A组66．67％（22／33），B组68．5％（24／35）。两组间差异无统计学意义。结论A组与B组比较，术后眼压更平稳；术后并发症的发生率低且其严重程度较轻。因此，A组的安全性明显高于B组，手术成功率相近。

Blood-retinal barrier as a converging pivot in understanding the initiation and development of retinal diseases

Clinical ophthalmologists consider each retinal disease as a completely unique entity.However,various retinal diseases,such as uveitis,age-related macular degeneration,diabetic retinopathy,and primary open-angle glaucoma,share a number of common pathogenetic pathways.Whether a retinal disease initiates from direct injury to the blood-retinal barrier(BRB)or a defect/injury to retinal neurons or glia that impairs the BRB secondarily,the BRB is a pivotal point in determining the prognosis as self-limiting and recovering,or developing and progressing to a clinical phenotype.The present review summarizes our current knowledge on the physiology and cellular and molecular pathology of the BRB,which underlies its pivotal role in the initiation and development of common retinal diseases.